Knee dislocation with multi-ligament injury: Evaluation, treatment and results

Awareness of the possibility of multiple ligament injuries in the traumatized knee is essential for the successful management of an injured knee. Relative infrequency of occurrence, heterogeneous presentation, inconsistent treatment protocols, ambiguity in the timing of surgery, post-surgical rehabilitation protocol, and paucity of literature on the subject make the situation perplexing. This study aims at the evaluation of a multi-staged protocol and determination of various factors having influence on outcome. This study included 39 patients with injury to two or more ligaments of the knee, without associated complications. Staged protocol of ligament surgery included repair or reconstruction of collaterals and corners in the initial stage, followed by reconstruction of posterior cruciate ligament (using Hamstring graft) and anterior cruciate ligament (using Bone Patellar Tendon Bone graft). Rehabilitation included two weeks of immobilization following repair/reconstruction of collaterals/corners followed by protected range of motion exercises. In final IKDC qualification, 10 knees (25.64%) were normal (A), 26 knees (66.6%) were near normal (B), 2 knees (5.1%) were abnormal (C), and 1 knee (2.56%) was severely abnormal (D). Our staged management protocol had good subjective, and objective outcomes, and nearly all patients, but two, returned to their routine activities.