Functional outcome following reconstruction in chronic multiple ligament deficient knees

Multiligament knee injuries are rare but potentially limb-threatening conditions. In this study we aim to evaluate the mid- and long-term functional outcome of patients who underwent arthroscopically assisted multiple ligament reconstruction for chronic multiple knee ligament deficiency. Thirty-five patients (27 males and 8 females) with an average age of 35.1 years (range: 17-60) were included in this study. Follow-up ranged from 12 to 124 months (average: 40.3). On final follow-up patients had a mean loss of extension of 3.1 degrees, while flexion ranged from 95 degrees to 135 degrees (average: 118.4 degrees). The functional outcome according to Clancy's criteria was excellent in 7 patients (20%), good in 14 (40%), fair in 11 (31.4%), while 3 reconstructions resulted in failure (8.6%). Patients scored an average of 4.03 (range: 1-9) in their Tegner Activity Scale, while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 25 to 98 with an average of 72.7. Sixteen patients returned to sporting activities and all but three returned to work. Early operative treatment of multiple ligament injuries is preferable, as it may allow for anatomic repair instead of reconstruction of ligamentous structures. This study demonstrates though, that even if acute reconstruction has not or could not be performed, reconstruction in chronic multiple ligament deficient knees should be attempted. Although this complex and technically demanding procedure rarely results in a "normal" knee, it offers in most cases very satisfactory stability and a significant improvement in knee function.