All-Autograft Algorithm Can Effectively Address Multiligament Knee Injuries: Rationale and Outcomes at Medium-Term Follow-Up


Iftach Hetsroni, MD, Associate Prof.
ISRAEL

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All-Autograft Algorithm Can Effectively Address Multiligament Knee Injuries: Rationale and Outcomes at Medium-Term Follow-Up

Iftach Hetsroni, MD, Associate Prof., ISRAEL Shanny Gur, MD, ISRAEL Mischa van Stee, BA, ISRAEL Gideon Mann, MD, Prof., ISRAEL Nissim Ohana, MD, ISRAEL

Meir Medical Center, Kfar Saba, ISRAEL

2025 Congress   ePoster Presentation   2025 Congress   Not yet rated

 

Sports Medicine

Orthopaedic Sports Medicine Sport Specific Injuries Outcome Studies

Diagnosis / Condition

Dislocation Trauma Instability

Treatment / Technique

Repair / Reconstruction Arthroscopy Autograft

Anatomic Location

Knee

Anatomic Structure

Ligaments

Ligaments

MC Ligament LC Ligament ACL PCL Posterolateral Corner

Summary: The suggested all-autograft algorithm effectively addresses multiple scenarios of multiligament knee injuries, supported by good outcomes in daily activities and return to moderate activities at medium-term follow-up. It is valuable in facilities where high-quality allograft tissue is not available, but can also become partially adopted to optimize cost-effective management of medical resources.

Objective

To describe all-autograft algorithm for the management of the multiligament-injured knee and report medium-term outcomes.

Methods

Due to unavailability of non-irradiated allograft tendons until 2020 in a specific medical facility, an all-autograft algorithm for managing multiligament knee injuries was developed and implementedin since 2013 a single sports medicine center. Accordingly, bone-Patellar tendon-bone, Quadriceps tendon-bone, Hamstrings and contralateral Semitendinosus autografts were used to address a spectrum of injury scenarios. At medium-term follow-up, patients underwent physical examination and completed outcome questionnaires (PROMs) and activity level scales, in addition to undergoing functional evaluations, including quadriceps strength measurements, sit-to-stand test, jump-squat test, and single-legged balance test, calculating their symmetry indices (SI).

Results

Twenty-five patients (20 men) were treated due to multiligament knee injuries between 2013 and 2020. Of these, 20 had clinical assessments at 4 to 10-year follow-up (6 KD-V; 2 KD-IV; 2 KD-III;2 KD-II; 8 KD-I). Age at operation=24 [mean] (range, 17.5-32). At follow-up, IKDC-subjective=79±16, KOOS-ADL=88±15, KOOS-Sports=66±27, MLQOL-Physical impairment=25±20, MLQOL-Activity limitation=29±22. Tegner [median]=4 (range, 1-7) compared to 7 (range, 3-10) at pre-injury. Quadriceps strength SI=14±16[%], Jump-squat SI=9±10[%]. Three cases underwent release of adhesions to improve flexion range at 2 months post-operatively. Schenk severity grade was associated with IKDC-subjective, KOOS, MLQOL, Tegner and Marx scales, and with Quadriceps strength at follow-up (r=0.4-0.6, p≤0.05). Among the entire cohort of 25 patients, there were no major intra- or postoperative complications (i.e no infections, significant harvest-site morbidities, iatrogenic neurovascular injuries, or VTE events).

Conclusions

The suggested all-autograft algorithm can effectively address multiple scenarios of multiligament knee injuries. This is supported by overall good functional outcomes in daily activities and return to moderate activities at medium-term follow-up although high activity levels in sports are generally not restored. This algorithm is valuable for medical facilities where high-quality allograft tissue is not readily available, but it can also become partially adopted elsewhere to limit the use of allograft tendons in complex knee surgery, thereby optimizing cost-effective management of medical resources.

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