OBJECTIVE: This study compared mid-term outcomes of two anterior cruciate ligament (ACL) restoration techniques within an early total surgical care of acute knee dislocation: repair with additional internal bracing (ACLIB) and reconstruction with autograft (ACLR). Initial results at 12 months demonstrated that ACLR offered superior stability compared to ACLIB.
METHODS: Retrospective clinical study of patients with acute type III or IV KD. ACLIB or ACLR procedures were performed accompanied by simultaneous suture and internal bracing of the posterior cruciate ligament (PCL) and repair with lateral augmentation of the medial and lateral complex injuries utilizing Arciero\'s reconstruction technique. Patient-reported outcome measurements (PROMs), instrumental stability assessment via the Rolimeter-Test, and stress radiographs were analyzed.
RESULTS: The study involved 20 patients (5 IIIM, 5 IIIL, and 10 IV injuries) with an average follow-up of 35.2 ± 7.4 months. Notable differences in anterior tibial translation on stress radiography favouring ACLR persisted at 24-month follow-up in side-to-side difference (SSD) (ACLIB 2.8 ± 2.5 mm vs. ACLR 0.3 ± 2.6 mm; p = 0.0487), but Rolimeter test variance diminished (SSD ACLIB 2.5 ± 0.9 mm vs. ACLR 1.8 ± 1.7 mm). Both groups showed excellent PROMs (Lysholm Score: ACLIB 84.4 ± 15.8 vs. ACLR 89.9 ± 9.0; IKDC Score: ACLIB 77.1 ± 16.2 vs. ACLR 77.7 ± 8.6).
CONCLUSIONS: Our results indicate improved anterior stability at 12 months, which persisted at 24 months after ACL reconstruction compared with ACL repair by stress radiography. Both groups showed favourable patient-reported outcomes throughout the follow-up period. Notable rates of postoperative knee stiffness were observed in both groups. These were successfully managed with early, one-time arthroscopic arthrolysis within the first seven months of treatment, resulting in no major range of motion limitations at the 24-month follow-up.
METHODS: Retrospective cohort study, III.

UNASSIGNED: There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature.
UNASSIGNED: To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression.
UNASSIGNED: Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up.
UNASSIGNED: Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.

OBJECTIVE: Postoperative knee stiffness is a common issue in multiligament knee injuries (MLKIs). This study aims to compare outcomes between MLKI patients who underwent postoperative arthroscopic lysis of arthrofibrosis (LOA) for limited range of motion (ROM) and those who did not.
METHODS: Thirty-one patients (10 IIIM, nine IIIL and 12 IV) were included in this retrospective clinical study with acute type III or IV knee dislocations, while two patients were lost to follow up. Thirteen patients underwent LOA at a mean of 18.7 ± 8.4 weeks (Group A), while 18 did not require this intervention (Group B). Patient-reported outcome measures (IKDC, Lysholm, VAS) and ROM were evaluated.
RESULTS: The average follow up period was 31.0 ± 10.2 months. The mean time to LOA was 19.4 ± 7.6 weeks and a significant increase in ROM was observed after LOA (flexion: before LOA: 83.8° ± 19.2, after LOA: 119.6° ± 9.9; P < 0.0001). There were no significant differences between groups regarding clinical scores (Lysholm: Group A 85.0 ± 13.4, Group B 84.6 ± 14.5; IKDC: Group A 74.3 ± 10.8, Group B 76.7 ± 14.7) and ROM (flexion: Group A 118.6° ± 9.8, Group B 124.3° ± 12.8). There were no complications regarding LOA.
CONCLUSIONS: Patients, whether undergoing LOA or not, performed equally well in terms of ROM and clinical scores at final follow up, while timing of LOA appears less critical. LOA is a simple, durable and safe method of treating ROM deficits in patients treated for acute knee dislocation, with very good results.

Objective  The purpose of this study was to evaluate the clinical and functional results of simultaneous reconstruction of the ACL and PCL with bilateral hamstring autografts. We hypothesized that this reconstruction technique results in less morbidity and has similar results to the ones published in the previous literature. Methods  Eighteen patients with bicruciate lesions were selected and treated by arthroscopic surgery with autologous hamstring tendons in a single-stage procedure. The thicker semitendinosus tendon (ST) and the two gracilis tendons (G) were used for a 6-strand PCL reconstruction. The thinner ST was used for a 3-strand ACL reconstruction. The average patient age at surgery was 31 years, and the minimum follow-up was 2 years. Function of the operated knee was evaluated according to the Lysholm scale. Anterior knee laxity was examined with a KT-1000 arthrometer. Posterior laxity was evaluated using stress radiographies. Results  Statistically significant improvements were found for all three measurements ( p  < 0.001). Knee function by the Lysholm score increased from 43.8 ± 4.1 to 89.9 ± 3.8 post-surgery. The average anterior knee laxity improved from 5.2 + -0.8 mm initially to 2.4 + - 0.5 mm post-surgery. The posterior translation of the tibia relative to the femur decreased from 10 ± 3.4 mm to 3 ± 1.6 mm post-surgery. No patient showed loss of motion in extension or knee flexion. Conclusion  The simultaneous bicruciate reconstruction with bilateral hamstring autograft is a valuable option to achieve good functional outcomes and ligamentous stability.

The case presented in this article is one of recurrent left posterior periprosthetic knee dislocation (PPKD) in a patient with altered mental status (AMS). The patient, a 69-year-old female with a complex medical history including dementia, Ménière\'s syndrome, and left total knee arthroplasty, presented to the emergency department with AMS whereupon a left PPKD was discovered. Less than three weeks before this presentation, she sustained a left PPKD during a previous admission. During her current admission, she sustained yet another left PPKD after trials of closed reduction and immobilization. The patient eventually underwent a left cemented revision total knee arthroplasty with a hinged prosthesis. The implant was noted to be stable, and the patient had minimal pain postoperatively with no vascular or neurological injury. Upon outpatient follow-up, the patient reported doing well. There have been few documented cases of recurrent or chronic PPKD in individuals with AMS or restricted intellect. These comorbidities create a complex approach to diagnosing and treating the aforementioned orthopedic injury, and as this injury can have devastating consequences, quickly and effectively delivering diagnosis and treatment is vital. This case highlights the importance of early identification, risk factors, preoperative management, and appropriate operative course for patients with AMS and recurrent PPKDs.

OBJECTIVE: Multiligament knee injuries (MLKIs) are devastating injuries that can have life-long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow-up.
METHODS: Four databases were queried for surgical outcome-based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2-year follow-up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow-up period, anatomical region and posterior-cruciate ligament (PCL)-based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random-effects model analysis was performed.
RESULTS: After the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow-up was 4.06 years (range 2-12.7). The mean Lysholm score at 2-year follow-up was 86.09 [95% confidence interval [CI]: 82.90-89.28], with a yearly decrease of -0.80 [95% CI: -1.47 -0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56-86.14], with a yearly decrease of -1.99 [95% CI: -3.14 -0.84] (p < 0.001). Non-PCL-based injuries had a higher IKDC 83.69 [75.55-91.82] vs. 75.00 [70.75-79.26] (p = 0.03) and Lysholm score 90.84 [87.10-94.58] versus 84.35 [82.18-86.52] (p < 0.01) than PCL-based injuries, respectively.
CONCLUSIONS: According to the present systematic review and meta-analysis of MLKIs with minimum 2-year follow-ups, the patients who suffered an MLKI can expect to retain around 80-85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL-based injuries at 2 years postoperative.
METHODS: Level IV meta-analysis.

Vascular injuries are serious complications of multiligament knee injuries and can result in catastrophic outcomes. These injuries can range from intimal flaps with no compromise of the distal perfusion to a complete occlusion or transection requiring emergent vascular intervention. Several diagnostic tests including the measurement of the ankle-brachial index (ABI), conventional angiography and computed tomography angiography (CTA) are commonly used as diagnostic tools to identify vascular injuries in the context of a multiligament knee injury. In this report, the authors discuss the case of a patient with a normal ABI and palpable distal pulses on physical examination who developed limb ischemia after a multiligament knee reconstruction under tourniquet. The patient underwent emergent embolectomy and had a favorable postoperative outcome. During vascular exploration, there was no evidence of injury to the popliteal artery. Therefore, the two working diagnoses were that the patient had an intimal flap complicated by the development of a thrombus during surgery, or that the initial vascular injury was not detected by ABI and clinical examination. Therefore, intimal flaps in multiligament knee injuries can lead to limb threatening ischemia in the context of reconstructive knee surgery and are likely underdiagnosed with ABI assessment. The utilization of preoperative CTA may help identify these injuries in patients indicated for reconstructive surgeries.

UNASSIGNED: Research and clinical studies on multiligamentous knee injuries (MLKI) have recently gained interest with several clinical studies reported recently. This study aims to identify, visualize, and characterize the MLKI research, to analyze the knowledge structure of MLKI during 2008-2023 and to identify the emerging research trends from a bibliometric perspective.
UNASSIGNED: All articles reporting MLKI from 2008 to 2023 were curated from the Scopus database, on 1st January 2024. VOS viewer and Microsoft Excel were used to analyze the publications including the participating countries, authors, organizations, journals and research focus. These data were used to generate visual knowledge maps of the outputs.
UNASSIGNED: 406 papers on MLKI were published in 115 journals by 483 authors. There has been a slow publication growth in the past 16 years. The United States had more than 50% share in global publications. Knee Surgery Sports Traumatology Arthroscopy, Orthopaedic Journal of Sports Medicine and American Journal of Sports Medicine published the most papers. The three USA institutions, namely Mayo Clinic, Hospital for Special Surgery-New York and Twin Cities Orthopedics contributed the largest number of publications. B.A. Levy (Mayo Clinic, USA) (n = 66) and M.J. Stuart (Mayo Clinic, USA) (n = 63) have registered the highest collaborative links with other authors.
UNASSIGNED: This study is the first comprehensive bibliometric study to analyze MLKI. The findings shed light on the growth trajectory of publications, the extent of international collaborations, the influence of highly cited articles, and the key countries, institutions, journals, and authors contributing to the field.
UNASSIGNED:
UNASSIGNED: The online version contains supplementary material available at 10.1007/s43465-024-01149-9.

UNASSIGNED: Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI.
UNASSIGNED: A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of relevant keywords encompassing \"multi-ligament knee injury,\" \"knee dislocation,\" \"reconstruction,\" \"repair,\" \"surgery,\" and \"timing,\" and their synonyms, along with appropriate Boolean operators. Selection of articles (systematic reviews and meta-analyses) adhered to predefined inclusion and exclusion criteria. Furthermore, a meta-analysis was conducted utilizing data extracted from primary studies.
UNASSIGNED: Early surgery for MLKI demonstrated a significant advantage over delayed surgery, reflected by significantly higher Lysholm scores (Mean Difference [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22), IKDC objective scores (Mantel-Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69), Tegner activity scores (MD 0.38; 95% CI 0.08, 0.69), and Mayer\'s ratings (MH-OR 5.47; 95% CI 1.27, 23.56). In addition, we found a significantly reduced risk of secondary chondral lesions (MH-OR 0.33; 95% CI 0.23, 0.48), lower instrumented anterior tibial translation in the early surgery group (MD -0.92; 95% CI -1.83, -0.01), but no significant difference was observed in the secondary meniscal tears, between the two groups. However, the early surgery group also exhibited a significantly increased risk of knee stiffness (MH-OR 2.47; 95% CI 1.22, 5.01) and a greater likelihood of requiring manipulation under anaesthesia (MH-OR 3.91; 95% CI 1.10, 13.87).
UNASSIGNED: Early surgery for MLKI improves function, and stability, and reduces further articular cartilage damage, but increases the risk of stiffness.
UNASSIGNED: IV.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s43465-024-01224-1.

BACKGROUND: Congenital knee dislocation (CKD) is a rare condition, which accounts for 1% of congenital hip dislocations. It can present as an isolated condition or coexist with other genetic disorders. Treatment options include serial casting, percutaneous quadriceps recession, and V-Y quadricepsplasty (VYQ). The pathogenesis and hereditary patterns of CKD are not fully understood, with most cases being familial. CKD is usually managed immediately after birth. However, in this report, the patient was neglected for 2 years.
METHODS: A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting; the patient had seizures and limited access to healthcare because of her family\'s low socioeconomic status. Her birth was noted for a breech presentation accompanied by oligohydramnios. The delivery took a long time, requiring immediate medical interventions. As an infant, she had chronic diseases, including a small patent ductus arteriole, multicystic dysplastic kidney disease, and epilepsy. She was found to have a bilateral knee dislocation of approximately -90° on hyperextension. A multidisciplinary team was involved, and medical care was optimized. She underwent VYQ plus semitendinosus and sartorius transfer. After four postoperative follow-ups, her knees were regaining mobility, and she could walk for 2-3 steps without assistance.
CONCLUSIONS: This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.