title: Surgical treatment of multiligament knee injuries.
abstract: OBJECTIVE
  To analyse one institution's experience with multiligament knee injuries.
  
  
  METHODS
  Over 10 years, 133 multiligament knee injuries including 130 patients were included in the study. Inclusion criteria included: (1) injury to two or more knee ligaments (2) multiligament knee repair/reconstructive surgery.
  
  
  RESULTS
  The average age at time of injury was 26 years old, and 76 % were male. Fifty-one (38 %) multiligament knee injuries had >2 ligaments injured. Peroneal injuries occurred in 26 patients (20 %), and four (3 %) had associated vascular injuries. A high energy mechanism of injury was noted in 39 %. Twenty-five per cent of patients had an additional orthopaedic injury and, 11.5 % suffered additional non-orthopaedic injuries. Definitive surgical intervention was performed acutely (<3 weeks) in 47 %. Ninety-one per cent of multiligament knee injuries underwent reconstruction with or without repair. Forty-three complications occurred in 37 patients. Patients who suffered >2 ligament injury or had surgery acutely were at an increased risk of knee stiffness requiring manipulation under anaesthesia (MUA) (p = 0.016 and p = 0.047, respectively). Knees with >2 ligaments injured were associated with higher post-operative complications (p = 0.007). Knee dislocation IV knees were at increased risk to undergo revision surgery (p = 0.041). Obese patients were more likely to have a post-operative infection (p = 0.038). Repair, reconstruction or type of graft used had no impact on need for revision surgery.
  
  
  CONCLUSIONS
  Multiligament knee injured patients undergoing surgical intervention are a highly complex patient population. This study outlines the patient population, treatment, and complications of one academic institution over 10 years. Overall complications were higher in patients with >2 ligaments injured. Knee stiffness requiring MUA was more common in patients who had >2 ligaments ruptured and those treated acutely. Knees with all four ligaments injured were more likely to undergo revision surgery.
  
  
  METHODS
  Retrospective case series, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. shane-cook-1@uiowa.edu.
authors.forename: Shane
authors.initials: S
authors.lastname: Cook
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. taylor-ridley@uiowa.edu.
authors.forename: T J
authors.initials: TJ
authors.lastname: Ridley
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. mark-mccarthy@uiowa.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: McCarthy
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. yubo-gao@uiowa.edu.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. brian-wolf@uiowa.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. ned-amendola@uiowa.edu.
authors.forename: Annunziato
authors.initials: A
authors.lastname: Amendola
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA. matthew-bollier@uiowa.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bollier
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery*; D008297:Male; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies
keywords: Complications; Knee dislocation; Multiligament knee injury; Treatment