Management of Multiligament Knee Injuries Using Anatomic Autograft Reconstructions: A Case Series

Abstract

While proven effective management of multiligament knee injury (MLKI) using allograft is often reported, it has shown an increased risk for graft failure compared with autograft and raises availability and cost issues. Osseous stock preservation and tunnel convergence avoidance led us to develop a compromise innovative surgical procedure using only ipsilateral autograft for anatomic reconstruction of Schenck III-L or higher MLKI. We report the description and early outcomes of our initial experience. Our strategy consisted of an anatomic single-bundle posterior cruciate ligament reconstruction with quadriceps tendon autograft and a “Versailles” reconstruction for the posterolateral corner, which we modified to reconstruct the anterolateral ligament in case of anteromedial rotatory instability, called “full lateral.” A second-stage surgery was planned for anterior cruciate ligament reconstruction using a bone–patellar tendon–bone autograft. Outcomes were Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores for functional status, Short Form 12 (SF-12) for quality of life, and visual analog scale (VAS) for pain. Complications, full weight-bearing, return to work, and sport were also computed. Between March 2019 and August 2020, 10 patients were included. At follow-up, light pain was found in nine patients with a mean VAS of 1.2 ± 2.16 during the day. The mean Lysholm, Tegner, and subjective IKDC scores were good, with 61.2 ± 20.6, 2.8 ± 2.1, and 52.6 ± 20.4, respectively. However, quality of life was altered with poor SF-12 scores. In our first 10 patients with Schenck III-L or higher MLKI, our procedure using only ipsilateral autograft enabled correct daily knee functional activities while preserving osseous stock.

Keywords

multiligament knee injury - autograft - reconstruction - surgical technique

Ethical Approval and Informed Consent

The local ethical review board approved the study, and written informed consent was obtained from each participant.

Authors' Contribution

C.M. designed and coordinated the study. L.C., C.M., H.B., B.B., and M.A.R. designed the treatment protocol. C.M. and H.B. designed the reconstruction technique. M.G. saw the patients at follow-up. M.G. and C.M. drafted the manual. B.B. and M.A.R. have revised the manual and M.A.R. has given the final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publication History

Received: 18 July 2024

Accepted: 04 September 2024

Article published online:
11 October 2024

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