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Updated: Jun 2, 2026

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
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Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

Published on: March 1, 2024

Approach to the Neglected Multiligament Knee Injury: A Systematic Review.

Prushoth Vivekanantha1, Aurneen Ashur2, Sebastian Kolde2

  • 1Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada.

Indian Journal of Orthopaedics
|June 1, 2026
PubMed
Summary

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This summary is machine-generated.

Neglected multi-ligament knee injuries require tailored treatment. Reconstruction is best for younger patients, while total knee arthroplasty suits older individuals, avoiding procedures causing severe stiffness.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Traumatology

Background:

  • Neglected multi-ligament knee injury (MLKI) is rare but has severe consequences.
  • Delayed treatment, often due to initial management by non-specialists, complicates outcomes.
  • Understanding injury patterns and treatment efficacy is crucial for improving patient care.

Purpose of the Study:

  • To review injury patterns in neglected MLKI.
  • To summarize current treatment recommendations for these complex injuries.
  • To analyze the outcomes associated with various management strategies.

Main Methods:

  • Systematic literature search of MEDLINE, PubMed, and EMBASE.
  • Inclusion of case reports on neglected MLKI (defined as delayed definitive surgery ≥3 weeks).
Keywords:
ArthrodesisArthrofibrosisArthroplastyArthroscopicChronicInjuriesKneeKnee dislocationMultiligament knee injuryNeglectReconstructionReplacementTotal knee arthroplastyTrans-articular pinning

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  • Adherence to PRISMA, R-AMSTAR, and Cochrane guidelines.

    • Main Results:

    • Eighteen case reports involving 19 patients were analyzed.
    • Mean delay to surgery was 47.8 months; most injuries presented unreduced.
    • Treatments included open MLKR (KOOS ≥70), TKA (often hinged), and arthrodesis; trans-articular pinning led to arthrofibrosis.

    Conclusions:

    • MLKI reconstruction is recommended for younger, non-arthritic patients.
    • Total knee arthroplasty (TKA) may be suitable for older patients, potentially requiring constrained implants.
    • Arthrodesis and trans-articular pinning should be avoided due to high risk of flexion contractures.