Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation.

PURPOSE: The purpose of this study was to determine the effectiveness of a new 2-stage surgical treatment for acute traumatic knee dislocation.
METHODS: The study involved 15 knees in 14 patients treated between October 1997 and November 2001. The mean follow-up was 88.9 months (range, 35 to 110 months). In the first surgical stage, medial or lateral ligament complexes were repaired or reconstructed within 2 weeks of injury. In the second surgical stage, once full range of motion was obtained 3 to 6 months later, the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) was reconstructed if significant laxity was present. The final outcomes were assessed based on stress radiographs, range of motion, Lysholm score, Tegner activity stage, and International Knee Documentation Committee rating.
RESULTS: There were 10 cases of medial collateral ligament (MCL) tear and 8 cases of lateral collateral ligament (LCL) tear. All MCL and LCL injuries were either repaired or reconstructed. All cases had both ACL and PCL tears. After the first stage of MCL/LCL complex surgery, the second-stage surgery involving ACL and PCL reconstruction was deemed necessary in 3 and 7 cases, respectively. Five cases did not require ACL or PCL reconstruction. On stress radiography at the last follow-up, MCL, LCL, ACL, and PCL instability was graded as 0 to 1 in 15, 14, 15, and 11 cases, respectively. PCL instability was graded as 2 in 4 cases. The mean postoperative Lysholm score was 87.6 points.
CONCLUSIONS: The 2-stage surgical approach described resulted in good outcomes for acute knee dislocation patients in terms of range of motion and stability. LEVEL OF EVIDENCE: Level IV, therapeutic case series.