Use of Internal Bracing in Multi-ligamentous Knee Injury Reconstruction: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Multi-ligament knee injuries (MLKI) result from high-energy trauma, causing significant joint instability.
• Surgical fixation, internal bracing, and suture augmentation are employed to restore stability and improve outcomes.
• This review evaluates the literature on internal bracing for MLKI management.

Purpose of the Study:

• To systematically review the current literature on the use of internal bracing in the management of MLKI.
• To assess the effectiveness of internal bracing in restoring knee stability and improving surgical outcomes.
• To analyze re-operation rates, failure rates, patient-reported outcome measures (PROMs), and stability findings.

Main Methods:

• Systematic review including randomized controlled trials, observational studies, cohort studies, and cross-sectional studies.
• Inclusion criteria: patients with MLKI managed with internal bracing or suture tape augmentation.
• Primary outcomes: re-operation and failure rates. Secondary outcomes: PROMs and knee stability examination findings.

Main Results:

• 13 studies were included from 282 screened; 5 involved Schenck grade III or higher injuries.
• Failure rates ranged from 0% to 13.6%.
• Lysholm scores (PROM) ranged from 61.8 to 95; stiffness requiring manipulation was a common complication.

Conclusions:

• Internal bracing for MLKI appears comparable in effectiveness to non-braced techniques.
• Post-operative PROMs and low failure rates suggest favorable outcomes for internal bracing in MLKI.
• Further prospective studies comparing braced vs. non-braced repairs are necessary to confirm benefits in stability and rehabilitation.