Summary

One-stage treatment for multiligament knee reconstruction combined with patellar tendon repair was effective in restoring joint stability and knee function

Abstract

Background

The association of multiligament knee injury and patellar tendon (PT) injury is rare and literature evidence is limited to guide treatment and the outcomes presented are a matter of debate.

Purpose

To compare the outcomes of multiligament knee reconstruction (MKR) and patellar tendon repair in a one-stage procedure in relation to a group without injury to the patellar tendon submitted to MKR.

Methods

Sixteen patients undergoing MKR and patellar tendon repair in a one-stage procedure were prospectively evaluated over a minimum follow-up of 2 years. These 16 patients had acute KD III and IV injuries according to the Schenck classification and the results were compared with 32 patients with acute KD III and IV injuries without patellar tendon injury. The subjective assessment took into account the Lysholm and the International Knee Documentation Committee (IKDC) scores, the Tegner activity scale and the patient satisfaction with the result. The objective assessment took into account the objective IKDC, the range of motion, stress radiographs and the time to return to work.

Results

A total of 89 patients underwent multiligament reconstruction of the knee resulting from high-energy trauma (motor vehicle accidents) between 2017 and 2021. Of the eighty-nine patients, 78 (87.6%) completed the follow-up with an average of 35 months (range, 24 – 51 months). Sixteen patients had acute KD III and IV injuries associated with PT injury and 32 patients had acute KD III and IV injuries without PT injury. There were no significant differences between the two groups in age, sex, body mass index and follow-up. There was significant difference in time to treatment (p<0.001), patients with PT injury the average time to treatment was 8 days (range, 4-11days) and in patients without PT injury this time was 16 days (range, 13-26 days). There was no significant difference between the two groups in relation to vascular injury, fibular nerve injury, joint exposure and chondral injury. A higher incidence of meniscal injuries was observed in individuals with PT injuries, when compared with those without PT injuries, with statistical significance (p = 0.014).
There was no significant difference (p>0.05) in the postoperative outcome scores, satisfaction, range of motion and stress radiographs when comparing patients undergoing MKR and patellar tendon repair in a single procedure in relation to the group undergoing MKR and without patellar tendon injury. There was significant difference in time to return to work (p<0.001), patients with PT injury the average time was 8,44 months (range, 5-12 months) and in patients without PT injury this time was 4,03 months (range, 3-6 months). All patients in the group with PT injury returned to work at the same level as before the injury, and in the group without PT injury, one patient required a change in work activity and the others returned to work at the same level.

Conclusion

Patellar tendon repair associated with a single-stage multiligament reconstruction of the knee and early rehabilitation was effective in restoring joint stability and knee function with outcome scores comparable to the group without patellar tendon injury.