Purpose
The purpose of this systematic review was to address the treatment of multiligament
knee injuries, specifically (1) surgical versus nonoperative treatment, (2) repair versus reconstruction of injured ligamentous structures, and (3) early versus late surgery of damaged ligaments.
Methods
Two independent reviewers performed a search on PubMed from 1966 to August 2007 using
the terms “knee dislocation,” “multiple ligament–injured knee,” and “multiligament
knee reconstruction.” Study inclusion criteria were (1) levels I to IV evidence, (2) “multiligament” defined as disruption of at least 2 of the 4 major knee ligaments,
(3) measures of functional and clinical outcome, and (4) minimum of 12 months' follow-up, with a mean of at least 24 months.
Results
Four studies compared surgical treatment with nonoperative treatment. There was a
higher percentage of excellent/good International Knee Documentation Committee (IKDC)
scores (58% v 20%) in surgically treated patients, as well as higher rates for return to work (72%
v 52%) and return to full sport (29% v 10%). Two studies compared repair with reconstruction of damaged structures, with
similar mean Lysholm scores (88 v 87) and excellent/good IKDC scores (51% v 48%). However, repair of the posterolateral corner had a higher failure rate (37%
v 9%). Similarly, repair of the cruciates yielded decreased stability and range of
motion and a lower return to preinjury activity levels (0% v 33%). There were 5 studies comparing early surgery (≤3 weeks) with late surgery.
Early treatment resulted in higher mean Lysholm scores (90 v 82) and a higher percentage of excellent/good IKDC scores (47% v 31%), as well as higher sports activity scores (89 v 69) on the Knee Outcome Survey.
Conclusions
Our review suggests that early operative treatment of the multiligament-injured knee
yields improved functional and clinical outcomes compared with nonoperative management
or delayed surgery. Repair of the posterolateral corner may yield higher revision
rates compared with reconstruction.
Key Words
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Article info
Footnotes
J.P.S. and P.A.M. have received research/institutional support from Smith & Nephew (Andover, MA) and Linvatec (Largo, FL).
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
