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Single-Stage vs. Multi-Stage Reconstruction in Multi-Ligament Knee Injuries: A Systematic Review and Meta-Analysis of
Monketh Jaibaji1, Omar Najim2, Hamza Alali3
1South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK.
Journal of Clinical Medicine
|October 16, 2025
Summary
Staged reconstruction for multi-ligament knee injuries (MLKIs) shows better outcomes. This approach resulted in fewer complications like arthrofibrosis and higher return-to-sport rates compared to single-stage surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Multi-ligament knee injuries (MLKIs) pose significant surgical challenges.
- Optimal surgical timing (single-stage vs. staged reconstruction) for MLKIs remains debated.
- Evidence comparing outcomes of single-stage versus staged MLKI reconstruction is limited.
Purpose of the Study:
- To compare complication rates, functional outcomes, and return-to-sport rates between single-stage and staged MLKI reconstruction.
- To identify factors influencing outcomes in MLKI surgical management.
- To inform surgical decision-making for complex knee injuries.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched PubMed, Scopus, Embase, and Cochrane Library (2000-2025).
- Extracted data on complications, Lysholm scores, return to sport, and graft types from 43 studies (2086 patients).
Main Results:
- Staged reconstruction demonstrated significantly lower arthrofibrosis rates (1.95% vs. 7.29%) and higher Lysholm scores (+4.7 points).
- Return-to-sport rates were higher with staged reconstruction (65% vs. 48%).
- Synthetic graft use correlated with increased arthrofibrosis risk.
Conclusions:
- Staged reconstruction appears superior to single-stage approaches for MLKIs regarding functional outcomes and complication reduction.
- Findings support individualized surgical strategies based on injury complexity and patient factors.
- Further research may refine optimal timing and graft selection for MLKI management.
