Complications of surgical reconstruction of multiligament injuries of the knee joint: diagnosis, prevention and treatment

Abstract

The main complications of surgical reconstruction of multiligament injuries of the knee joint are residual or recurrent instability, arthrofibrosis, popliteal artery injury, common peroneal nerve injury, compartment syndrome, fluid extravasation, symptomatic heterotopic ossification, wound problems and infection, deep venous thrombosis, and revision surgery.Careful surgical planning and execution of the primary surgical reconstruction of multiligament injuries of the knee joint can minimize the risk of the aforementioned complications.Careful postoperative follow-up is required to detect complications. Early recognition and prompt treatment are of paramount importance.To obtain good results in the revision surgery of failed multiligamentary knee reconstructions, it is crucial to perform a thorough and exhaustive evaluation to detect all the causes of failure.Addressing all associated injuries during revision surgery will lead to the best possible subjective and objective results, although functional outcomes are often modest.However, advanced age and high-energy injuries have been associated with the poorest functional outcomes after revision surgery of failed multiligament injuries of the knee joint. Cite this article: EFORT Open Rev 2021;6:973-981. DOI: 10.1302/2058-5241.6.210057.

Keywords: knee; multiligament injury; surgical reconstruction.

Fig. 1

Intraoperative image of anatomical reconstruction of the posterolateral corner (PLC). A vessel loop has been placed separating the peroneal nerve; the two needles mark the tunnels of the lateral collateral ligament (LCL) and the popliteal tendon, which are 18 mm apart. For this procedure, a tunnel must be made in the fibula and a tunnel in the tibia.

Fig. 2

Anatomical reconstruction of the posteromedial corner (PMC). (a) The needles mark the tunnels for this reconstruction. (b) The grafts of the superficial collateral ligament and the posterior oblique ligament (POL) fixed in the femur are observed.

Fig. 3

Image of preparation of a posterior cruciate ligament (PCL) reconstruction by inlay technique with double femoral fascicle and image of Achilles allograft (a) and (b) used for multiligamentous reconstructions. (c) Intraoperative fluoroscopic control is essential.