Reconstruction and/or Repair of The Multi-Ligament Knee Injury: A Systematic Review

Background: A paucity of data exists regarding the comparison of outcome scores following multiple ligament knee injury (MLKI) reconstruction/repair methods.

Purpose: The purpose of this study was to conduct a systematic review of the literature on patient outcomes following reconstruction and/or repair of the MLKI.

Study Design: Systematic review of level IV studies

Methods: This review study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Pubmed and Cochrane were analyzed using the following search strategy: “(((multi ligament knee injury) OR multiple ligament knee injury) AND reconstruction) AND repair”. Inclusion criteria for articles were as follows: 1) human subjects 2) follow up of at least mean 12 months 3) outcome studies following surgical ligament reconstruction and/or repair after multiple ligament knee injury 4) reported objective outcome data on respective patient cohorts. The exclusion criteria included: case reports, technique papers, and articles without paired pre and post-operative objective findings.

Result: 109 studies were initially retrieved, with 7 satisfying all inclusion criteria. The review included a total of 183 patients; 126 males and 57 females. The average age was 36.3 (29.6-45.3). The 7 studies included ligamentous reconstruction, repair and reconstruction/repair techniques via a one-stage and two-staged method. The weighted mean Lysholm scores significantly improved from 30.3 +/- 4.2 preoperatively to 86.2 +/- 5.6 post-operatively (paired t-test; p<0.001).

Conclusion: A review of the current literature concludes that surgical ligamentous repair and/or reconstruction of the MLKI yields a significant improvement from pre-operative to post-operative Lysholm scores. This suggests that surgical intervention provides benefit to patients in this population. Other outcome scores have insufficient data to conduct a statistical analysis.

Keywords: Multiple ligament knee injury; Multiple knee ligament reconstruction; Multiple knee ligament repair; Knee ligament

Abbreviations: MLKI-multiple-ligament knee injury