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Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

Goyal Tarun|Paul Souvik|Banerjee Sushovan|Das Lakshmana
대한슬관절학회 (Korean Knee Society)|2021.12|Knee Surgery and Related Research|제33권 |pp. 3-3|DOI 10.1186/s43019-020-00083-y

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키워드

Anterior cruciate ligamentPosterior cruciate ligamentKnee dislocationMultiligamentMedial collateral ligament

초록

This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts.All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score ( p = 0.0001) IKDC score ( p = 0.0001), Lysholm score ( p = 0.0001), and range of motion ( p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes.Level IV, case series.

Abstract

This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts.All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score ( p = 0.0001) IKDC score ( p = 0.0001), Lysholm score ( p = 0.0001), and range of motion ( p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes.Level IV, case series.

참고문헌 (52)

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Combined PCL and PLC Reconstruction Improves Residual Laxity in PCL Injury Patients with Posterolateral Knee Laxity Less Than Grade III박상훈, 오현철, 윤한국, 최희민, 하중원연세대학교의과대학 · Yonsei Medical Journal2023 · 제64권 제5호A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries박용범, Han Sang-Jin, Kim Dong-Hyun, Kim Seong Hwan, Lee Han-Jun, Pujol Nicolas대한슬관절학회 · Knee Surgery and Related Research2021 · 제33권 Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial MeniscusDevendra K. Chouhan, Kevin Syam, Mandeep Singh Dhillon대한슬관절학회 · Knee Surgery and Related Research2017 · 제29권 제1호Proprioception and Clinical Results of Anterolateral Single-Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation곽병훈, 손욱진, 이동철, 이성준대한슬관절학회 · Knee Surgery and Related Research2013 · 제25권 제3호Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta‑analysisAriel de Lima Diego, de Lima Lana Lacerda, de Moraes Perez Rodrigo Amorim, de Souza Nayara Gomes Reis, Guimarães Tales Mollica, Helito Camilo Partezani, Sobrado Marcel Faraco대한슬관절학회 · Knee Surgery and Related Research2021 · 제33권 Morphologic Changes of the Posterior Cruciate Ligament on Magnetic Resonance Imaging before and after Reconstruction of Chronic Anterior Cruciate Ligament Ruptures유재두, Hyung Mook Lim대한슬관절학회 · Knee Surgery and Related Research2012 · 제24권 제4호

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