Khan Mohammad Jesan, Asif Naiyer, Sharma Anubhav, Siddiqui Yasir Salam, Khan Abdul Qayyum
Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, A.M.U. Aligarh 202002, Uttar Pradesh, India.
Int J Burns Trauma. 2022 Apr 15;12(2):35-44. eCollection 2022.
Multi ligament knee injury (MLKI) refers to the disruption of at least 2 of the 4 major knee ligaments. These injuries are managed in single and two-stage surgeries however, treatment guidelines for best practice are unsettled. There is no study in the literature that compares single and two-stage surgery for the management of chronic multiligament knee injury. Therefore, the aim of this study was to compare the functional outcome between single-stage and two-stage surgical fixation in chronic multi-ligament knee injury.
Twenty seven patients with chronic MLKI with at least 2 years of follow up were included. Fourteen patients underwent reconstruction of torn ligaments in a single-stage operation (Group I) and 13 patients underwent reconstruction of torn ligaments in two stages (Group II). Assessment of clinical outcome was done with IKDC knee score, TEGNER LYSHOLM knee score, range of movement and laxity tests (Anterior drawer test, Lachman, Posterior drawer test, pivot shift test, dial test, varus and valgus stress test).
At final follow up, there was no significant difference in post-operative IKDC knee scores in group I and group II (84.7±7.1 and 81.4±8.4 respectively, p=0.3) and Lysholm scores (85.8±8.3 and 80.9±8.3 respectively, p=0.1), range of movement (133.2±5.7 and 131.5±6.6 respectively, p=0.5) and all the patients regained full extension. At the final follow up 12/14 patients (85.7%) in group I and 11/13 patients (84.6%) in group II had a negative/grade 1 anterior drawer test (p=0.6), 14/14 (100%) in group I and 13/13 (100%) patients had negative/grade 1 lachman test (p=0.6), 13/14 patients (92.8%) in group I and 13/13 patients (100%) patients in group II had negative/grade 1 pivot shift test (p=0.4), 9/10 patients (90%) in group I and 12/13 patients (92.3%) in group II had negative/grade 1 posterior drawer (p=0.6), 6/6 patients (100%) in group I and 6/7 patients (85.7%) in group II had negative/grade 1 dial test (p=0.3), 5/6 patients (83.3%) in group I and 5/7 patients (71.4%) in group II had negative/grade 1 varus stress test (p=0.4), 6/7 patients (85.7%) in group I and 7/7 patients (100%) in group II had negative/grade 1 valgus stress test (p=0.1).
Chronic MLKI managed by single stage and two stage reconstruction provides similar functional outcomes.
Level III Retrospective Cohort Study.
膝关节多韧带损伤（MLKI）是指四大主要膝关节韧带中至少两条发生断裂。这些损伤通过一期和二期手术进行治疗，然而，最佳治疗方案的指南尚未确定。文献中没有研究比较一期和二期手术治疗慢性膝关节多韧带损伤的效果。因此，本研究的目的是比较慢性膝关节多韧带损伤一期和二期手术固定的功能结局。
纳入27例慢性MLKI患者，随访至少2年。14例患者在一期手术中重建撕裂的韧带（第一组），13例患者分两期重建撕裂的韧带（第二组）。采用IKDC膝关节评分、TEGNER LYSHOLM膝关节评分、活动范围和松弛度测试（前抽屉试验、拉赫曼试验、后抽屉试验、轴移试验、旋转试验、内翻和外翻应力试验）评估临床结局。
在最后随访时，第一组和第二组术后IKDC膝关节评分（分别为84.7±7.1和81.4±8.4，p = 0.3）、Lysholm评分（分别为85.8±8.3和80.9±8.3，p = 0.1）、活动范围（分别为133.2±5.7和131.5±6.6，p = 0.5）无显著差异，所有患者均恢复了完全伸直。在最后随访时，第一组12/14例患者（85.7%）和第二组11/13例患者（84.6%）前抽屉试验为阴性/1级（p = 0.6），第一组14/14例患者（100%）和第二组13/13例患者（100%）拉赫曼试验为阴性/1级（p = 0.6），第一组13/14例患者（92.8%）和第二组13/13例患者（100%）轴移试验为阴性/1级（p = 0.4），第一组9/10例患者（90%）和第二组12/13例患者（92.3%）后抽屉试验为阴性/1级（p = 0.6），第一组6/6例患者（100%）和第二组6/7例患者（85.7%）旋转试验为阴性/1级（p = 0.3），第一组5/6例患者（83.3%）和第二组5/7例患者（71.4%）内翻应力试验为阴性/1级（p = 0.4），第一组6/7例患者（85.7%）和第二组7/7例患者（100%）外翻应力试验为阴性/1级（p = 0.1）。
一期和二期重建治疗慢性MLKI的功能结局相似。
III级回顾性队列研究。
