Clinical efficacy of one-stage repair and reconstruction of multiple ligament injury of the knee joint under an arthroscope / 解放军医学杂志

ABSTRACT

Objective To investigate the clinical features of multiple ligament injuries of the knee joint, and evaluate the clinical efficacy of one-stage repair and reconstruction under an arthroscope of multiple ligament injured knee joint. Methods The clinical data were analyzed retrospectively of 22 patients receiving treatment and follow-up for multiple ligament injuries of the knee joint from March 2015 to June 2017 in the Henan Orthopedic Hospital. 13 males and 9 females aged from 24 to 64 years; and left knee injury occurred in 7 cases, right knee in 5 cases, all injuries were close with knee subluxation or dislocation. Imaging, clinical and arthroscopical examination showed anterior and posterior cruciate ligament ruptures in all the patients. The time from injury to operation was from 4 to 16 days, all the patients were treated by single tunnel and single beam reconstruction of anterior and posterior cruciate ligament under an arthroscope, limited incision and reconstruction of PMC (posterior medial complex) and PLC (posterior lateral complex); and the concurrent injuries were treated at that same time. Postoperative X-Ray and MRI were performed to determine the healing of bone tunnel, internal fixation, remodeling of reconstructed tendon and tendon healing. The knee function was assessed on the basis of the range-of-motion of the knee, IKDC score and Lysholm Knee Function score. Results All the patients were followed up from 6 to 14 months with an average of (11.0±1.5) months. The torn inner and outer meniscus and fracture were all healed and the deep venous thrombus was dissolved. Last follow up found varus and valgus stress test was normal or close to normal in 22 patients by Lachman test, anterior and posterior drawer tests were negative, and the tibial shift distance forward or backward was smaller than 5mm. The patients had no subjective symptoms. X-Ray and MRI showed that the tibial femoral tunnel had healed, and the position of internal fixation had no change, and the ligament had been reconstructed and the tendon had healed. In 2 cases, one year later, sensory and motor recovery was observed after common peroneal nerve injury. Range of motion of the knee joint, and Lysholm and IKDC scores were significantly superior at the last following up to at the preoperation (P<0.01); and IKDC comprehensive assessment revealed a normal result (A) in 4 cases, close to normal (B) in 16, abnormal (C) in 2, whereas they are significantly abnormal (D) at admission. Conclusion One-stage arthroscopical repair and reconstruction for multiple ligament injuries of the knee can obviously stabilize the knee joint, improve the knee joint function early, prevent postoperative complications, shorten the hospitalization time, reduce the cost, improve the quality of life, and have the advantages of safety, reliability and less trauma, and the clinical efficacy is satisfactory.