Vermorel Pierre-Henri, Ravelojaona Marion, Bruyere Gilles, Klasan Antonio, Philippot Rémi, Grange Sylvain, Neri Thomas
Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, EA 7424, France; Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023, Saint-Etienne, France.
Clinique Universitaire du Sport et de l'Arthrose, 28 Av. Pierre Mendès France, 42270 Saint-Priest-en-Jarez, France.
Orthop Traumatol Surg Res. 2025 Sep 11:104424. doi: 10.1016/j.otsr.2025.104424.
The prognosis of multi-ligament knee injury (MLKI) can be severe despite modern treatment approaches. It is influenced by the severity of associated damage, lesion pattern, and the course of pre-, peri-, and postoperative management.The aim of our study was to compare multiligament knee reconstruction (MLKR) cases involving both the ACL and PCL with those involving either the ACL or PCL in terms of one-year postoperative outcomes. Additionally, we assessed factors influencing outcomes at one year, functional and clinical results, as well as return to work (RTW) and return to sport (RTS) at the one-year follow-up.
We hypothesized that MLKR cases involving both the ACL and PCL would lead to poorer outcomes compared to those involving only one of the cruciate ligaments.
Seventy-two patients were included in the study between October 2019 and April 2023. Diagnosis was based on a 3 T MRI combined with clinical examination, and MLKI was classified according to the five-level Schenck classification. Anatomical ligament reconstruction was performed, followed by a structured postoperative physiotherapy program in a specialized reference center. Functional outcomes were assessed using IKDC, KOOS, and Tegner, along with isokinetic muscle strength testing (quadriceps, hamstrings), VAS pain scores, and return to sport and work at the one-year follow-up. IKDC and KOOS scores were compared between patients with a single cruciate ligament injury (Schenck I) and those with both cruciate ligaments involved (Schenck > I). A multivariate analysis was conducted to identify factors associated with poor outcomes at one year postoperatively.
Patients with only one cruciate ligament involved in the MLKR had better IKDC and KOOS at one-year post- operative in comparison with patients with both cruciate ligaments involved (p < 0.05). Age has a negative correlation with KOOS and IKDC (p < 0.05), Tegner has a positive correlation with KOOS (p < 0.05). All patients had a strength deficit in quadriceps and hamstring contraction at one-year post-operative compared to the uninjured knee. Mean KOOS was 72.1 ± 20.1 [19;100], mean IKDC was 71.1 ± 19.9 [18;95.4] and mean VAS was 1.6 ± 1.9 [0;8]. Return to work was observed in 89% (n = 64), and 76.4% (n = 55) returned to sports.
Combined injuries involving both the ACL and PCL are associated with a poorer prognosis compared to isolated injuries of either ligament. At one-year follow-up, MLKR allows most patients to return to work; however, return to physical activity remains more uncertain. Residual strength deficits persist in both the quadriceps and hamstring muscles.
III; Retrospective comparative study.
尽管有现代治疗方法，膝关节多韧带损伤（MLKI）的预后仍可能很严重。它受相关损伤的严重程度、损伤模式以及术前、术中和术后管理过程的影响。我们研究的目的是比较涉及前交叉韧带（ACL）和后交叉韧带（PCL）的多韧带膝关节重建（MLKR）病例与仅涉及ACL或PCL的病例在术后一年的结果。此外，我们评估了影响一年后结果的因素、功能和临床结果，以及在一年随访时的重返工作岗位（RTW）和恢复运动（RTS）情况。
我们假设与仅涉及一条交叉韧带的MLKR病例相比，涉及ACL和PCL两者的MLKR病例会导致更差的结果。
2019年10月至2023年4月期间，72例患者纳入本研究。诊断基于3T磁共振成像（MRI）结合临床检查，MLKI根据五级申克分类法进行分类。进行了解剖学韧带重建，随后在一个专门的参考中心进行结构化的术后物理治疗计划。使用国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎疗效评分（KOOS）、泰格纳活动水平评分（Tegner）以及等速肌力测试（股四头肌、腘绳肌）、视觉模拟评分法（VAS）疼痛评分评估功能结果，并在一年随访时评估重返运动和工作情况。比较了单纯交叉韧带损伤（申克I级）患者和两条交叉韧带均受累（申克> I级）患者的IKDC和KOOS评分。进行多变量分析以确定与术后一年不良结果相关的因素。
与两条交叉韧带均受累的患者相比，MLKR中仅涉及一条交叉韧带的患者在术后一年时的IKDC和KOOS评分更高（p < 0.05）。年龄与KOOS和IKDC呈负相关（p < 0.05），泰格纳评分与KOOS呈正相关（p < 0.05）。与未受伤的膝关节相比，所有患者在术后一年时股四头肌和腘绳肌收缩均存在力量不足。平均KOOS为72.1±20.1 [19; 100]，平均IKDC为71.1±19.9 [18; 95.4]，平均VAS为1.6±1.9 [0; 8]。89%（n = 64）的患者重返工作岗位，76.4%（n = 55）的患者恢复运动。
与单独的ACL或PCL损伤相比，ACL和PCL联合损伤的预后较差。在一年随访时，MLKR使大多数患者能够重返工作岗位；然而，恢复体力活动仍更不确定。股四头肌和腘绳肌仍存在残余力量不足。
III级；回顾性比较研究。
