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Management of Multiligament Knee Injuries Using Anatomic Autograft Reconstructions: A Case Series
Maxime Guerot1, Baptiste Boukebous1, Lucas Chanteux1
1Department of Orthopedic and Traumatology, Beaujon Hospital, Clichy, France.
The Journal of Knee Surgery
|October 11, 2024
Summary
This study introduces an innovative surgical technique for multiligament knee injuries (MLKI) using only autografts. The procedure shows promise for restoring knee function while preserving bone stock, though quality of life scores require further investigation.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Knee Reconstruction
Background:
- Allograft use in multiligament knee injury (MLKI) management presents risks of graft failure, availability issues, and high costs.
- Autografts offer an alternative but require careful surgical planning for complex injuries.
- Preserving osseous stock and avoiding tunnel convergence are critical considerations in MLKI reconstruction.
Purpose of the Study:
- To describe an innovative, two-stage surgical procedure for severe MLKI (Schenck III-L or higher) utilizing exclusively ipsilateral autografts.
- To evaluate the early clinical outcomes, functional status, quality of life, and pain levels associated with this novel technique.
- To assess the feasibility of the "full lateral" modification for addressing anteromedial rotatory instability.
Main Methods:
- Anatomic single-bundle posterior cruciate ligament reconstruction with quadriceps tendon autograft and a modified "Versailles" posterolateral corner reconstruction ("full lateral").
- A second-stage anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft.
- Outcome assessment included Lysholm, Tegner, IKDC, SF-12, and VAS scores, along with complication tracking and return-to-activity metrics.
Main Results:
- Ten patients with severe MLKI underwent the procedure between March 2019 and August 2020.
- Early follow-up showed good functional outcomes with mean Lysholm (61.2), Tegner (2.8), and subjective IKDC (52.6) scores.
- Patients experienced mild pain (mean VAS 1.2), but reported diminished quality of life (SF-12 scores).
Conclusions:
- This ipsilateral autograft-only technique provides a viable option for anatomic reconstruction of severe MLKI, preserving osseous stock.
- The procedure facilitates functional daily knee activities.
- Further research is needed to address the impact on long-term quality of life and optimize patient outcomes.
