多重靭帯膝関節損傷における外科的戦略と機能的転帰の評価：インド人患者を対象とした前向き研究

Multiligamentous knee injuries (MLKIs) are uncommon yet complex, presenting challenges in diagnosis, treatment, and rehabilitation. This study aims to evaluate the incidence, causes, surgical techniques, and functional outcomes of MLKI cases in Indian patients.

A prospective study was conducted at a tertiary care center. Patients underwent surgical intervention based on clinical evaluation, employing both single-stage and staged reconstruction strategies. The sequence of ligament repair and graft selection was tailored to each case. Post-operative outcomes were assessed using the knee society score (KSS) and Lysholm score.

70 MLKI cases were treated between January 2021 and July 2023, with two patients lost to follow-up, all patients had anterior cruciate ligament injuries, with additional ligament involvement observed in posterior cruciate ligament (24%), medial collateral ligament (32%), and posterolateral corner (27%). Meniscal injuries were noted in 40% of cases. Graft selection included semitendinosus and gracilis tendons (54%) and peroneus longus (46%), with an average graft diameter of 8 ± 1 mm. No significant differences in outcomes were found between graft types (P > 0.05). At 6 months post-surgery, the mean KSS improved from 51 ± 10 to 80 ± 5, while Lysholm scores increased from 60 ± 10 to over 80. Notably, 90% of patients achieved excellent results.

Early, well-planned single-stage reconstruction emerges as an effective strategy for managing MLKIs, yielding favorable functional outcomes. Tailoring surgical approaches based on individual injury profiles significantly optimizes recovery.