Advertisement

Revision Multi-ligament Knee Reconstruction: Treatment Algorithm and Outcomes

      Introduction

      The treatment of knee dislocations remains challenging, and there is limited evidence available to guide treatment after failed multi-ligament reconstruction. The purpose of this study is to (1) present an algorithm describing surgical decision-making in the setting of revision multi-ligament reconstruction, and (2) assess clinical outcomes of this algorithm at a minimum of two years after surgery.

      Methods

      We identified patients from our prospective multi-ligament database that underwent revision of multi-ligament reconstruction between 1992-2013 for persistent instability after failed primary reconstruction and/or repair. Patient demographic information (age, gender, BMI), injury description (mechanism of injury, neurovascular status, specific ligaments injured, associated chondral or meniscal injury), surgical technique (repair vs. reconstruction, staged vs. non-staged, concomitant procedures), mechanism of failure, as well as IKDC and Lysholm scores were obtained.

      Results

      The cohort consisted of 19 patients (6 female, 13 male), with an average age of 31±12 years (range 17-59 years) who underwent revision of multi-ligament knee reconstruction with a mean follow-up of 47±27 months. Thirteen (70%) patients underwent at least one additional procedure (mean 1.2, range 0-4) to correct other underlying pathology in preparation for revision reconstruction. Five (26%) patients underwent staged revisions with bone grafting of the tibial/femoral tunnels. Two (11%) patients underwent staged osteotomies, one distal femoral and one proximal tibial. One (5%) patient underwent concomitant meniscal transplant at time of revision. For revision surgeries, 17 (89%) underwent reconstruction only, and 2 (11%) underwent combined repair/reconstruction. Average IKDC and Lysholm scores were 66±26 and 71±23 respectively. High-energy mechanism of injury (p=0.04) and increased age at primary surgery (p=0.03) are associated with lower Lysholm scores.

      Conclusion

      This algorithm offers a systematic approach for treatment of failed multi-ligament knee reconstruction. Revision multi-ligament surgery can achieve modest outcomes in selected patients Non-modifiable risk factors associated with worse outcome include increased patient age and a high-energy injury.