Summary

Good range of motion and satisfactory functional outcome with minimal complications can be achieved with early single stage surgery in these high-energy injuries thereby avoiding staged surgery which increases cost and requires multiple hospital admissions.

Abstract

Aims and Objectives:

To report the patient-reported outcomes (PROMs) after early single stage Multi-ligament knee surgery. We hypothesized that early single-stage surgery results in a stable, pain-free functional knee with minimal risk of complications especially post-op arthrofibrosis often associated with delayed/staged surgery.

Materials And Methods

We conducted a Retrospective case cohort study comprising all patients operated for multi-ligament knee injury between Jan 2012-Dec 2021 by a single surgeon in a multi-specialty tertiary care hospital. The Inclusion criteria were all adult patients operated for Multi-ligament knee injury between Jan 2012- Dec 2021 with a minimum 2-year follow-up and willing to participate in the study. We excluded patients who underwent delayed surgery, those with less than 2-year follow –up and if they underwent any previous surgery in the injured knee. There were 24 patients (M=19, F=5) with mean age of 27.8 years. The mechanism of injury varied from Road traffic accident (RTA= 14), Sports = 6, Low energy= 4 patients. As per the MLKI classification, there were KDIII = 17, KDIV = 4, KDII = 2, KDV = 1 patient. The follow-up ranged from 2-10 years (average = 6.2 years) and patients were evaluated using validated objective and subjective functional outcomes criteria.

Results

All patients attended periodic follow-up when the knee was assessed objectively for swelling, stability, range of motion and Tegner-Lysholm, IKDC scores were used for subjective evaluation. No patients were lost to follow-up. At the time of final follow-up, the range of motion was -5 to140 (average extension 0, flexion 120). The mean Tegner-Lysholm score was 85 and IKDC 76. The early complications were arthrofibrosis = 3 patients which resolved with physiotherapy, Peroneal nerve neuropraxia = 1 patient which self-resolved whilst the late complications were asymptomatic residual laxity = 2 patients, secondary OA = 1 patient.

Conclusion

Our results showed that a good range of motion and satisfactory functional outcome with minimal complications can be achieved with early single-stage surgery in these high-energy injuries thereby avoiding staged surgery which increases cost and requires multiple hospital admissions.