LONG-TERM RESULTS OF PATIENTS WITH MULTIPLE KNEE LIGAMENT INJURIES

Abstract

The long-term results of patients with multiple knee ligament injuries, i.e. at least 3 ligament ruptures, including both cruciates, in patients entered prospectively onto the trauma database between 1985 and 1999, were reviewed. Forty patients with this injury had modified Lysholm scores at long term follow-up a mean of 8 years post-injury. The mode of operative treatment fell into 3 groups: direct suture or screw fixation of avulsions (Group 1), mid-substance ruptures treated with cruciate reconstruction with hamstring tendons (Group 2), or suture repairs of mid-substance ruptures (Group 3). All operative procedures were undertaken within 2 weeks of injury. Non-operative treatment involved a cast or spanning external fixator (2–4 weeks) followed by bracing. Statistical analysis was performed on the Lysholm scores.

The 40 patients in the study group were predominantly young males, 40% had polytrauma, 33% had isolated injuries. Thirteen patients (33%) had non-operative management, the remainder had early operative treatment of their ligament injuries, tailored to the type of ligament injuries identified.

Long-term patient outcome data shows statistically significant differences (p< 0.05) between the best results, in patients with direct fixation of bony avulsions (mean = 89), followed by those who had early hamstring reconstruction (mean = 79), followed by those who underwent simple ligament repairs (mean = 65). There was a statistically significant difference (p< 0.05) between the overall scores for the operative group (mean = 80) compared with the non-operative group (mean = 50).

Operative treatment of multiple ligament injuries, particularly fixation of avulsions and primary reconstruction of the posterior cruciate ligament appears to yield better results than non-operative or simple repair in the long term follow-up in this group with significant knee injuries.