Background

Multiligament knee injuries raise multiple treatment dilemmas. Graft choice is one controversial topic in this respect. While allograft use reduces donor site morbidities and shorten surgical times, the reduced costs with the lack of disease transmission and graft rejection risks, alongside fast graft-host incorporation are advantages when using autografts. This purpose of this study is to present all-autograft algorithm for managing multiligament knee injuries developed and adopted in our department and report respective cases treated according to this algorithm.

Methods

Young adults treated according to an all-autograft algorithm between 2011 and 2020 were reviewed. In the acute phase posterolateral injuries were repaired and augmented with autografts, while cruciate bony avulsions and plateau fractures had acute repair. Midsubstance cruciate tears received initially nonoperative rehabilitation, except cases with severely high-grade disrupted PCL tears which mandated acute reconstruction of the cruciate ligaments. In the chronic phase all symptomatic instabilities were reconstructed. Autografts used included bone-patellar tendon-bone, Quadriceps tendon-bone, hamstring tendons, and contralateral hamstrings tendons.

Results

There were 25 patients (20 men), and age range was 17-40 YO. There were 11 KD-I, 2 KD-II, 5 KDIII, 2 KD-IV, and 5 KD-V cases. At follow-up, medial and lateral-posterolateral sides restored nearly symmetric stability except one case. All repairs of ACL and PCL bony avulsions restored nearly symmetric stability. ACL reconstructions restored symmetric stability, while PCL reconstructions resulted in Grade 1+ minimal posterior laxity. Four cases underwent arthroscopic adhesiolysis at 3-6 months which improved successfully their range of flexion. There were no cases of lack of extension, no infections, and no thromboembolic events. Patient satisfaction was high with return to Tegner level 7-10 in the KD-I cases, and return to light activities Tegner level 3-5 in the KD-II, III, IV and V cases.

Conclusions

Multiligament knee injuries can be successfully managed with autograft-based approach. This approach is valuable in facilities where high-quality non-irradiated allograft tissue is not readily available, or in combination with allograft use according to surgeon's preference and patient factors.