High Rate of Return to Previous Sport Level in Professional Athletes After Knee Dislocations Treated With Single-Stage Reconstruction: A Retrospective Case Series

Abstract

Background: Knee dislocations leading to multiligament knee injuries (MLKIs) in professional athletes are rare. Restoring athletes to preinjury sport levels is challenging and crucial because of their physical demands. Existing research on MLKIs lacks conclusive recommendations regarding repair/reconstruction techniques and staging as well as the ligament repair sequence for predicting return to play (RTP).

Purpose/hypothesis: The purposes were to (1) assess the RTP rate, time to RTP, and rate of return to previous levels and (2) analyze the reoperation rate in a cohort of professional athletes treated for knee dislocations with single-stage repair/reconstruction. The hypothesis was that a single-stage surgical approach and an individualized postoperative protocol would enable these patients to return to their previous professional sport levels.

Study design: Case series; Level of evidence, 4.

Methods: Consecutive professional athletes who underwent surgery after sustaining a knee dislocation (types III-V) between 2007 and 2022, with a minimum 2-year follow-up, were included. Collected information included demographic and injury characteristics, surgical procedures, and postoperative outcomes. Primary outcomes were RTP rates, time to RTP, and rates of return to previous levels, with reoperation rates and complications as secondary outcomes.

Results: There were 9 elite athletes included with a mean age of 26.6 years and a mean preoperative Tegner activity score of 9.5 (range, 8-10). The mean follow-up period was 5.8 years (range, 2-15 years). All patients underwent surgery within 3 weeks, except for 1 patient who required initial vascular treatment. At a mean of 12 months (range, 8-22 months), 88.8% of professional athletes returned to their preinjury level, with the exception of 1 patient with a traumatic injury of the common peroneal nerve. The mean postoperative International Knee Documentation Committee score was 89.9 (range, 71.3-97.7), the mean postoperative Lysholm score was 91.1 (range, 80-98), and the mean postoperative Tegner score was 8.5 (range, 3-10). At the last follow-up, 3 athletes had retired for reasons unrelated to their knees. Additionally, 3 patients (33.3%) required further surgery for early stiffness, with 2 patients undergoing arthroscopic arthrolysis and 1 patient undergoing manipulation under anesthesia with screw removal. No other complications were observed.

Conclusion: Early single-stage surgery in professional athletes with MLKIs after knee dislocations led to high rates of RTP and return to previous levels. Postoperative stiffness requiring surgical intervention was seen in one-third of patients.

Keywords: knee dislocation; multiligament knee injury; return to previous sport level; return to sport; single-stage reconstruction.

Figure 1.

Radiography and magnetic resonance imaging of a right knee, showing a (A) posterolateral knee dislocation (type III-L), (B) complete rupture of the lateral collateral ligament (white star), and (C) bicruciate ligament rupture (white circle).

Figure 2.

Flowchart diagram.

Figure 3.

(A, B) Superficial medial collateral ligament rupture (white star) and tibial capsular avulsion and meniscotibial ligament (blue star). (C) Common peroneal nerve (CPN; white arrow). (D) Popliteal tendon avulsion (blue arrow).

Figure 4.

(A) Anterolateral view. Common graft of anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) to avoid multiple tunnels. Anatomic graft position for posterior cruciate ligament (PCL) and popliteus tendon. (B). Medial compartment view. Posterior oblique ligament (POL) and superficial medial collateral ligament (MCL) reconstruction with independent grafts.