EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION OF TRAUMATIC DISLOCATION OF KNEE JOINT COMBINED WITH MULTIPLE LIGAMENT INJURIES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANGWu ¹ ,  YAOJianhua ¹ , KONGDejia ² , SUNWei ³ , HUANGYan ³ , ZHENGHuayong ³ , LIUChen ³ , BAOXianguo ¹

1. Clinical College of General Hospital of Beijing Military Area Command, Anhui Medical University, Beijing, 100700, P. R. China;
2. Clinical College of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Beijing, 100700, P. R. China;
3. Department of Orthopaedics, General Hospital of Beijing Military Area Command, Beijing, 100700, P. R. China;

Corresponding author：

YAOJianhua, Email: dryaojianhua@163.com

Keywords：

Knee joint; Multiple ligament injuries; Arthroscopy; Repair and reconstruction

DOI：

10.7507/1002-1892.20140180

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of one-stage repair and reconstruction of multiple ligament injuries of the knee under arthroscopy. Methods Between March 2007 and March 2009,25 patients (25 knees) with multiple ligament injuries of the knee underwent one-stage repair and reconstruction under arthroscopy.Of 25 cases,16 were male and 9 were female with an average age of 29.6 years (range,18-43 years).The causes of injury were traffic accident injury in 20 cases,falling injury from height in 3 cases,and sport injury in 2 cases.The time between injury and surgery was 8-14 days (mean,10.5 days).The preoperative Lysholm score was 37.92±3.57.The X-ray film and MRI examinations showed that 17 patients had tears of anterior cruciate ligament (ACL),posterior cruciate ligament (PCL),and medial collateral ligament,and 8 patients had tears of ACL,PCL,and posterolateral corner (PLC);5 cases had medial meniscus injury and 7 cases had lateral meniscus injury.The ACL,PCL,and PLC were reconstructed under arthroscopy with autologous tendon or allogeneic tendon,and the MCL was repaired.Early active and passive functional exercises were done postoperatively. Results All the incisions healed by first intention,and there was no complications of infection and deep venous thrombosis.Twenty-five patients were followed up 24-78 months (mean,50.9 months).Six patients had knee stiff postoperatively;after manipulation under anesthsia,5 patients lost less than 15° of flexion and only 1 patient lost 26° of flexion.At last follow-up,the stability of the knee joint was significantly improved.There were significant differences in the anterior drawer test,posterior drawer test,Lachman test,and varus stress and valgus stress testing at 30° between at last follow-up and at preoperation (P<0.05).The postoperative Lysholm score was 87.84±4.85,which was significantly better than the preoperative score (t=52.053,P=0.000).The International Knee Documentation Committee (IKDC) rating was nearly normal in 16 cases (64%),abnormal in 8 cases (32%),and obviously abnormal in 1 case (4%). Conclusion One-stage repair and reconstruction of multiple ligament injuries of the knee under arthroscopy can effectively restore the function of the knee joint,and the effectiveness is reliable.

Citation： JIANGWu, YAOJianhua, KONGDejia, SUNWei, HUANGYan, ZHENGHuayong, LIUChen, BAOXianguo. EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION OF TRAUMATIC DISLOCATION OF KNEE JOINT COMBINED WITH MULTIPLE LIGAMENT INJURIES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 810-813. doi: 10.7507/1002-1892.20140180 Copy

1.	Howells NR,Brunton LR,Robinson J,et al.Acute knee dislocation:an evidence based approach to the management of the multiligament injured knee.Injury,2011,42(11):1198-1204.
2.	Subbiah M,Pandey V,Rao SK,et al.Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee.J Orthop Surg (Hong Kong),2011,19(3):297-302.
3.	Li X,Liu T.Surgical management of multiple ligamengt injuries.Eur J Orthop Surg Traumatol,2013,23(6):691-697.
4.	Colosime AJ,Carroll PF,Heidt RS Jr,et al.Simultaneous ACL and PCL reconstruction.J Knee Surg,2003,16(4):191-196.
5.	Fanelli GC,Edson CJ.Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee:2to 10-year follow-up.Arthroscopy,2002,18(7):703-714.
6.	皇甫小桥,赵金忠,何耀华,等.膝关节多发韧带损伤的修复与重建.中华骨科杂志,2011,31(2):164-168.
7.	陈平泉,朱振康,王胜.膝前、后交叉韧带与内侧副韧带损伤的一期修复重建.中国修复重建外科杂志,2012,26(6):675-678.
8.	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.Orthop Surg,2013,5(4):239-249.
9.	Fanelli GC,Edson CJ.Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity):surgical technique and 2to 18-year results.J Knee Surg,2012,25(4):307-316.
10.	Ibrahim SA,Ghafar S,Salah M,et al.Surgical management of traumatic knee dislocation with posterolateral corner injury.Arthroscopy,2013,29(4):733-741.
11.	Brautigan B,Johnson DL.The epidemiology of knee dislocations.Clin Sports Med,2000,19(3):387-397.
12.	刘玉杰,敖英芳,陈世益.膝关节韧带损伤修复与重建.北京:人民卫生出版社,2008:217.
13.	Peskun CJ,Whelan DB.Outcomes of operative and nonoperative treatment of multiligament knee injuries:an evidence-based review.Sports Med Arthrosc,2011,19(2):167-173.
14.	Stannard JP,Bauer KL.Current concepts in knee dislocations:PCL,ACL,and medial sided injuries.J Knee Surg,2012,25(4):287-294.
15.	Gauffin H,Rockborn P.Knee dislocations:is reconstruction of the posterior cruciate ligament crucial? Eur J Orthop Surg Traumatol,2014,24(3):371-377.
16.	Heitmann M,Gerau M,Hötzel J,et al.Ligament bracing-augmented primary suture repair in multiligamentous knee injuries.Oper Orthop Traumatol,2014,26(1):19-29.
17.	Darabos N,Gusic N,Vlahovic T,et al.Staged management of knee dislocation in polytrauma injured patients.Injury,2013,44 Suppl 3:S40-45.
18.	Frosch KH,Preiss A,Heider S,et al.Primary ligament sutures as a treatment option of knee dislocations:a meta-analysis.Knee Surg Sports Traumatol Arthrosc,2013,21(7):1502-1509.
19.	Liow RY,McNicholas MJ,Keating JF,et al.Ligament repair and reconstruction in traumatic dislocation of the knee.J Bone Joint Surg (Br),2003,85(6):845-851.
20.	Harner CD,Waltrip RL,Bennett CH,et al.Surgical management of knee dislocations.J Bone Joint Surg (Am),2004,86-A(2):262-273.
21.	Ibrahim SA,Ahmad FH,Salah M,et al.Surgical management of traumatic knee dislocation.Arthroscopy,2008,24(2):178-187.
22.	Ohkoshi Y,Nagasaki S,Shibata N,et al.Two-stage reconstruction with autografts for knee dislocations.Clin Orthop Relat Res,2002,(398):169-175.
23.	Bin SI,Nam TS.Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation.Arthroscopy,2007,23(10):1066-1072.
24.	Wascher DC,Becker JR,Dexter JG,et al.Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation.Results using fresh-frozen nonirradiated allografts.Am J Sports Med,1999,27(2):189-196.
25.	Lee MC,Park YK,Lee SH,et al.Posterolateral reconstruction using split Achilles tendon allograft.Arthroscopy,2003,19(9):1043-1049.

1. Howells NR,Brunton LR,Robinson J,et al.Acute knee dislocation:an evidence based approach to the management of the multiligament injured knee.Injury,2011,42(11):1198-1204.
2. Subbiah M,Pandey V,Rao SK,et al.Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee.J Orthop Surg (Hong Kong),2011,19(3):297-302.
3. Li X,Liu T.Surgical management of multiple ligamengt injuries.Eur J Orthop Surg Traumatol,2013,23(6):691-697.
4. Colosime AJ,Carroll PF,Heidt RS Jr,et al.Simultaneous ACL and PCL reconstruction.J Knee Surg,2003,16(4):191-196.
5. Fanelli GC,Edson CJ.Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee:2to 10-year follow-up.Arthroscopy,2002,18(7):703-714.
6. 皇甫小桥,赵金忠,何耀华,等.膝关节多发韧带损伤的修复与重建.中华骨科杂志,2011,31(2):164-168.
7. 陈平泉,朱振康,王胜.膝前、后交叉韧带与内侧副韧带损伤的一期修复重建.中国修复重建外科杂志,2012,26(6):675-678.
8. 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.Orthop Surg,2013,5(4):239-249.
9. Fanelli GC,Edson CJ.Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity):surgical technique and 2to 18-year results.J Knee Surg,2012,25(4):307-316.
10. Ibrahim SA,Ghafar S,Salah M,et al.Surgical management of traumatic knee dislocation with posterolateral corner injury.Arthroscopy,2013,29(4):733-741.
11. Brautigan B,Johnson DL.The epidemiology of knee dislocations.Clin Sports Med,2000,19(3):387-397.
12. 刘玉杰,敖英芳,陈世益.膝关节韧带损伤修复与重建.北京:人民卫生出版社,2008:217.
13. Peskun CJ,Whelan DB.Outcomes of operative and nonoperative treatment of multiligament knee injuries:an evidence-based review.Sports Med Arthrosc,2011,19(2):167-173.
14. Stannard JP,Bauer KL.Current concepts in knee dislocations:PCL,ACL,and medial sided injuries.J Knee Surg,2012,25(4):287-294.
15. Gauffin H,Rockborn P.Knee dislocations:is reconstruction of the posterior cruciate ligament crucial? Eur J Orthop Surg Traumatol,2014,24(3):371-377.
16. Heitmann M,Gerau M,Hötzel J,et al.Ligament bracing-augmented primary suture repair in multiligamentous knee injuries.Oper Orthop Traumatol,2014,26(1):19-29.
17. Darabos N,Gusic N,Vlahovic T,et al.Staged management of knee dislocation in polytrauma injured patients.Injury,2013,44 Suppl 3:S40-45.
18. Frosch KH,Preiss A,Heider S,et al.Primary ligament sutures as a treatment option of knee dislocations:a meta-analysis.Knee Surg Sports Traumatol Arthrosc,2013,21(7):1502-1509.
19. Liow RY,McNicholas MJ,Keating JF,et al.Ligament repair and reconstruction in traumatic dislocation of the knee.J Bone Joint Surg (Br),2003,85(6):845-851.
20. Harner CD,Waltrip RL,Bennett CH,et al.Surgical management of knee dislocations.J Bone Joint Surg (Am),2004,86-A(2):262-273.
21. Ibrahim SA,Ahmad FH,Salah M,et al.Surgical management of traumatic knee dislocation.Arthroscopy,2008,24(2):178-187.
22. Ohkoshi Y,Nagasaki S,Shibata N,et al.Two-stage reconstruction with autografts for knee dislocations.Clin Orthop Relat Res,2002,(398):169-175.
23. Bin SI,Nam TS.Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation.Arthroscopy,2007,23(10):1066-1072.
24. Wascher DC,Becker JR,Dexter JG,et al.Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation.Results using fresh-frozen nonirradiated allografts.Am J Sports Med,1999,27(2):189-196.
25. Lee MC,Park YK,Lee SH,et al.Posterolateral reconstruction using split Achilles tendon allograft.Arthroscopy,2003,19(9):1043-1049.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION OF TRAUMATIC DISLOCATION OF KNEE JOINT COMBINED WITH MULTIPLE LIGAMENT INJURIES

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