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Review
. 2024 Nov;17(11):476-483.
doi: 10.1007/s12178-024-09923-w. Epub 2024 Aug 23.

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction

Zachary J Herman  1 , Janina Kaarre  2   3 , Anja M Wackerle  2   4 , Ariana Lott  2 , Nicholas A Apseloff  2 , Bryson P Lesniak  2 , James J Irrgang  5 , Volker Musahl  2
Affiliations
Review

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction

Zachary J Herman et al. Curr Rev Musculoskelet Med. 2024 Nov.

Abstract

Purpose of review: To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'.

Recent findings: Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking. While current literature mostly suggests early treatment, there is also evidence preferring delayed treatment. Furthermore, evidence on the timing of postoperative rehabilitation is limited. Thus, the current multi-center randomized controlled study, the 'STaR trial', is expected to respond to these questions by adding new high-level evidence. The MLKIs are often associated with knee dislocation and constitute a highly complex entity, including concomitant injuries, such as neurovascular, meniscal, and cartilaginous injuries. The treatment of MLKIs usually aims to either repair or reconstruct the injured ligaments, however, there is no general consensus on the timing of surgery or rehabilitation following an MLKI surgery. This current review stresses the need for more high-level research to address the paucity of evidence-based treatment guidelines for the treatment of complex MLKIs.

Keywords: Complications; MLKI; Multiligamentous knee injury; Outcomes; Rehabilitation; Surgery; Timing.

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Conflict of interest statement

The authors declare the following potential conflicts of interest or sources of funding: BPL received payment from Mid-Atlantic Surgical Systems, LLC for education. JJI is President of the Board of Directors for the Journal of Orthopaedic and Sports Physical Therapy (JOSPT). VM received consulting fees from Smith & Nephew and Newclip, educational fees from Arthrex, DePuy Synthesis, and Conmed, and is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), and the Assistant editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). Also, VM has a patent, U.S. Patent No. 9,949,684, issued on April 24, 2018, to the University of Pittsburgh.

Figures

Fig. 1
Fig. 1
MRI of MLKI involving ACL, PCL, and PLC. ACL = anterior cruciate ligament; MLKI = multiligamentous knee injury; MRI = magnetic resonance imaging; PCL = posterior cruciate ligament; PLC = posterolateral corner
Fig. 2
Fig. 2
X-ray of Posterior Tibiofemoral Dislocation and Reduced Tibiofemoral Joint
See this image and copyright information in PMC

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