Kekatpure Aashay, Kekatpure Aditya, Deshpande Sanjay, Srivastava Sandeep, Saoji Kiran
Department of Orthopaedic Surgery, DMMC, Nagpur, Maharashtra, India.
Department of Orthopaedic Surgery, DMIMS, Wardha, Maharashtra, India.
J Orthop Case Rep. 2023 Jul;13(7):121-125. doi: 10.13107/jocr.2023.v13.i07.3778.
Multiligament knee injuries (MLKIs) are difficult to manage occurrence and are usually associated with poor functional outcomes. Knee dislocations involving both cruciate ligaments are relatively rare compared to other multifilament injuries involving one cruciate ligament and a collateral ligament. Multiple studies have reported the Tegnor score after surgery as 3 or 4. In 44% of cases with posterolateral corner (PLC) injury and biceps femoris tendon rupture or avulsion of the fibular head, a palsy of the common peroneal nerve (CPN) occurs. About half of these cases do not exhibit functional recovery.
A 20 years old long jump national athlete sustained varus and hyperextension injury leading to a multiligament knee injury (anterior cruciate ligament, posterior cruciate ligament, PLC, and medial collateral ligament) and CPN palsy. After a staged surgical procedure and structured rehabilitation protocol, the athlete was able to return to preinjury level in 18 months. At present, 4 years postoperatively, the patient can walk full weight-bearing with no instability. On the latest follow-up, the Lachman's test is negative, posterior drawer test negative, varus, and valgus stress test negative. Knee ranges of motion 0 to 140 degrees. The patient reported that Tegnor Score was 8.
Surgical management of MKLI with CPN palsy can give reasonable functional outcome.
膝关节多韧带损伤（MLKIs）治疗困难，通常功能预后较差。与涉及一条交叉韧带和一条侧副韧带的其他多韧带损伤相比，涉及两条交叉韧带的膝关节脱位相对少见。多项研究报告术后Tegnor评分为3或4。在44%伴有后外侧角（PLC）损伤以及股二头肌肌腱断裂或腓骨头撕脱的病例中，会出现腓总神经（CPN）麻痹。其中约一半病例未表现出功能恢复。
一名20岁的国家跳远运动员遭受内翻和过伸损伤，导致膝关节多韧带损伤（前交叉韧带、后交叉韧带、PLC和内侧副韧带）以及CPN麻痹。经过分阶段手术和结构化康复方案，该运动员在18个月后恢复到受伤前水平。目前，术后4年，患者可完全负重行走且无不稳定感。在最近一次随访中，拉赫曼试验阴性，后抽屉试验阴性，内翻和外翻应力试验阴性。膝关节活动范围为0至140度。患者报告Tegnor评分为8分。
伴有CPN麻痹的MKLI手术治疗可取得合理的功能预后。
