Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

[1]  Charles H. Brown,et al.  Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation , 2018, Knee Surgery, Sports Traumatology, Arthroscopy.

[2]  U. Sheth,et al.  Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review , 2018, Journal of ISAKOS.

[3]  J. P. van der List,et al.  Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury , 2018, Arthroscopy techniques.

[4]  A. Amendola,et al.  Patient-Reported Outcomes After Multiligament Knee Injury , 2017, Orthopaedic journal of sports medicine.

[5]  A. Imhoff,et al.  Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction. , 2016, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[6]  Xingyi Hua,et al.  Single-stage in situ suture repair of multiple-ligament knee injury: a retrospective study of 17 patients (18 knees) , 2016, BMC Musculoskeletal Disorders.

[7]  Samuel A. Taylor,et al.  Primary Repair of the Anterior Cruciate Ligament: A Systematic Review. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[8]  A. Exadaktylos,et al.  Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. , 2015, Injury.

[9]  Y. Huang,et al.  The timing of surgical treatment of knee dislocations: a systematic review , 2015, Knee Surgery, Sports Traumatology, Arthroscopy.

[10]  Mark D. Miller,et al.  Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. , 2009, The Journal of bone and joint surgery. American volume.

[11]  R. Marx,et al.  Decision making in the multiligament-injured knee: an evidence-based systematic review. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  B. Owens,et al.  Primary Repair of Knee Dislocations: Results in 25 Patients (28 Knees) at a Mean Follow-up of Four Years , 2007, Journal of orthopaedic trauma.

[13]  M. Richter,et al.  Comparison of Surgical Repair or Reconstruction of the Cruciate Ligaments versus Nonsurgical Treatment in Patients with Traumatic Knee Dislocations , 2002, The American journal of sports medicine.

[14]  G. Fanelli,et al.  Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[15]  J. Uribe,et al.  Arthroscopic posterior cruciate ligament repair. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[16]  G. N. Zoys Knee dislocations. , 2001, Orthopedics.

[17]  V. Condello,et al.  Comparison of surgical treatments for knee dislocation. , 1999, The American journal of knee surgery.

[18]  F. Noyes,et al.  Reconstruction of the Anterior and Posterior Cruciate Ligaments After Knee Dislocation , 1997, The American journal of sports medicine.

[19]  M. F. Sherman,et al.  The long-term followup of primary anterior cruciate ligament repair , 1991, The American journal of sports medicine.