title: Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee.
abstract: OBJECTIVE
  To review treatment outcome of our staged protocol for multiple ligament injuries of the knee.
  
  
  METHODS
  21 men who were treated for multiple ligament injuries of the knee and had completed at least one year of rehabilitation were evaluated. Patients were examined under anaesthesia and then by diagnostic arthroscopy. Arthroscopic reconstructive procedures for injured cruciate ligaments were performed after a minimum 110º flexion and full extension were regained. Collateral ligaments injuries were treated first, followed by posterior cruciate ligament (PCL) and then anterior cruciate ligament (ACL) tears. Outcome was evaluated using the Lysholm knee score and International Knee Documentation Committee (IKDC) knee ligament evaluation form.
  
  
  RESULTS
  19 patients aged 24 to 55 (mean, 36) years were followed up for a mean of 22 (range, 14-33) months. The mean Lysholm score was 92. The mean scores for patients treated within and after 3 weeks were 93 and 90, respectively. The overall IKDC grading was B in 15 knees and C and D each in 2 knees. For the 2 patients with grade D, one presented 19 months after the injury and had persistent posterior sag (secondary to capsular contracture). His Lysholm score was 82. The second patient developed a deep infection and endured a flexion loss of 30º but had a satisfactory Lysholm score of 94. There was no significant difference between early and delayed treatments and between low- and high-velocity injuries in terms of the Lysholm score, the IKDC grade, the range of movement, and the functional outcome.
  
  
  CONCLUSIONS
  Staged management of multiple ligament injuries of the knee enabled satisfactory restoration of function, stability, and range of movement in most of our patients. By staging the procedures, the need for subsequent ACL reconstruction can be better evaluated, as ACL reconstruction is not necessary in patients not undertaking strenuous activities.
authors.affiliation: Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. subbuorth@yahoo.co.in
authors.forename: M
authors.initials: M
authors.lastname: Subbiah
authors.forename: Vivek
authors.initials: V
authors.lastname: Pandey
authors.forename: Sharath K
authors.initials: SK
authors.lastname: Rao
authors.forename: Sripathi
authors.initials: S
authors.lastname: Rao
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D031221:Knee Dislocation / Q000601:surgery; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult