title: Single-stage in situ suture repair of multiple-ligament knee injury: a retrospective study of 17 patients (18 knees).
abstract: BACKGROUND
  Multiple-ligament injured knee (MLIK) is a rare but severe injury. Although the principles of MLIK management have progressed over the past 40 years, there is a paucity of high-quality evidence upon which to base the management of MLIK. Treatment strategies for MLIK are challenging for most orthopedic surgeons, and the optimal treatment remains controversial, especially with regard to repair vs. reconstruction of the ligaments. The aim of the present study was to observe clinical outcomes of single-stage in situ suture repair of knee dislocation with multiple-ligament injury using nonabsorbable suture material.
  
  
  METHODS
  Consecutive patients with MLIK between 2002 and 2010 were included, for a total of 25 patients with knee dislocation. 17 patients (18 knees) with closed knee dislocation with a mean follow-up of 4.8 ± 1.3 years were retrospective analyzed. All patients were treated surgically with single-stage in situ suture repair for all injured ligaments and followed a standardized postoperative rehabilitation protocol. The VAS score, satisfactory score, total SF-36 score, Lysholm score, Tegner score, the Meyers functional rating and the ranges of motion and knee stability were used to evaluate outcomes.
  
  
  RESULTS
  At final follow-up, mean visual analog scale score was 2.4 ± 0.9, patient satisfaction score was 8.0 ± 1.1, 36-item Short-Form Health Survey total score was 85.5 ± 10.4, and mean Lysholm score was 87.5 ± 7.7. There were significant differences between mean preinjury and postoperative Tegner activity scores (5.6 ± 1.4 and 3.4 ± 1.7, respectively; P < 0.01) and in mean range of motion between the injured and contralateral knees (112.5 ± 8.4° and 129.6 ± 10.3°, respectively; P < 0.01). At final follow-up, no patient demonstrated obvious ligamentous laxity, and only one patient was unable to return to work. Three patients had knee joint stiffness, two had wound problems (infection or fat liquefaction), and two had heterotopic bone formation.
  
  
  CONCLUSIONS
  Single-stage in situ suture repair of injured ligaments confers advantages of reliable fixation and early exercise. It could be considered as an alternate and effective option in the dislocation knee with multiple-ligament injury.
authors.affiliation: Department of Orthopaedic Surgery, the First Affiliated Hospital of Anhui Medical University, No.218 Ji-xi Road,Hefei, Anhui, 230022, People's Republic of China. flyfox100@126.com.
authors.forename: Xingyi
authors.initials: X
authors.lastname: Hua
authors.affiliation: Department of Orthopaedic Surgery, the First Affiliated Hospital of Anhui Medical University, No.218 Ji-xi Road,Hefei, Anhui, 230022, People's Republic of China. taoh19870131@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Tao
authors.affiliation: Department of Orthopaedic Surgery, the First Affiliated Hospital of Anhui Medical University, No.218 Ji-xi Road,Hefei, Anhui, 230022, People's Republic of China. fangwang97@126.com.
authors.forename: Wang
authors.initials: W
authors.lastname: Fang
authors.affiliation: Department of Orthopaedic Surgery, the First Affiliated Hospital of Anhui Medical University, No.218 Ji-xi Road,Hefei, Anhui, 230022, People's Republic of China. aytangjian@163.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Tang
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D013537:Sutures / Q000706:statistics & numerical data; D055815:Young Adult