Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Abstract

Background: Multiligamentous injuries of knee remain a gray area as far as guidelines for management are concerned due to absence of large-scale, prospective controlled trials. This article reviews the recent evidence-based literature and trends in treatment of multiligamentous injuries and establishes the needful protocol, keeping in view the current concepts.

Materials and methods: Two reviewers individually assessed the available data indexed on PubMed and Medline and compiled data on incidence, surgical versus nonsurgical treatment, timing of surgery, and repair versus reconstruction of multiligamentous injury.

Results: Evolving trends do not clearly describe treatment, but most studies have shown increasing inclination toward an early, staged/single surgical procedure for multiligamentous injuries involving cruciate and collateral ligaments. Medial complex injuries have shown better results with conservative treatment with surgical reconstruction of concomitant injuries.

Conclusion: Multiligamentous injury still remains a gray area due to unavailability of a formal guideline to treatment in the absence of large-scale, blinded prospective controlled trials. Any in multiligamentous injuries any intervention needs to be individualized by the presence of any life- or limb-threatening complication. The risks and guarded prognosis with both surgical and non-surgical modalities of treatment should be explained to patient and relations.

Keywords: Arthroscopy; Orthopedics; arthroscopy; bi-cruciate injury; knee dislocation; knee injury; multiligament injury; multiligamentous injury; systematic review.

Flowchart 1

Protocol of management of multiligamentous injury of knee

Flowchart 2

Protocol for stable multiligamentous injury