Results of Treatment of the Multiple Ligament Injured (Dislocated) Knee

Background: Injuries to multiple knee ligaments, particularly those involving the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and associated lateral ligaments, present significant orthopedic challenges. These injuries typically occur due to high-energy trauma such as sports-related accidents or vehicular collisions, leading to severe instability and potential complications. The optimal treatment approach, involving various surgical strategies proposed to enhance functional outcomes, continues to be a subject of debate among physicians. This study evaluates the outcomes of different surgical methods for treating multiple ligament injuries in the knee, focusing on personalized treatment strategies. Methods: This study involved a retrospective analysis of ۳۲ patients with multiple ligament injuries to the knee. These patients were treated during the acute phase using three distinct surgical strategies: (۱) single-stage reconstruction, where all torn ligaments were repaired or reconstructed in one procedure (۱۲ patients); (۲) staged reconstruction, where extra-articular ligaments were addressed first, followed by intra-articular ligaments in a second procedure (۱۱ patients); and (۳) extra-articular ligament repair, where only extra-articular ligaments were repaired (۹ patients). Clinical evaluations included preoperative imaging and postoperative assessments with a mean follow-up of ۳۴.۷ months, focusing on knee stability and functional scores using the Lysholm score and the International Knee Documentation Committee (IKDC) grading. Results: The findings indicated significant improvement in all surgical groups post-treatment. Statistical analysis showed increased knee stability (P < ۰.۰۱), with a notable rise in functional scores as the Lysholm score significantly improved (P < ۰.۰۱), along with the IKDC scores (P < ۰.۰۱). Moreover, none of the patients exhibited severe instability or gait abnormalities at the final follow-up. Comparative analysis revealed a significant difference in Lysholm scores between the single-stage group and the extra-articular repair group (P = ۰.۰۴۰), suggesting that more comprehensive surgical interventions yield better functional outcomes. Additionally, two subscale scores for knee injury and osteoarthritis outcomes showed significant differences (P < ۰.۰۵), reinforcing the effectiveness of staged or combined approaches. Conclusion: This study concludes that satisfactory clinical and functional outcomes can be achieved through personalized surgical strategies for knees with multiple ligament injuries. While all approaches demonstrated effectiveness, the combination of extra-articular repair with intra-articular reconstruction appears particularly beneficial for younger, active patients. This research also underscores the importance of appropriate treatment plans that consider individual patient needs and injury profiles to optimize recovery and effectively restore knee function.

کلیدواژه ها:

Multiple Ligament Injury ، ACL Reconstruction ، PCL Reconstruction ، Knee Dislocation ، Surgical Strategies ، Knee Stability ، Functional Outcomes ، Rehabilitation