title: Results of multiple ligament injured knees operated by three different strategies.
abstract: BACKGROUND
  Multiple ligament injured knee is generally described for a scenario when at least 2 of the 4 major ligaments are ruptured. The most effective treatment for these injuries remains controversial. This study presents the clinical outcome of 3 surgical strategies based on personalized treatment.
  
  
  METHODS
  Thirty two patients with multiple ligament injured knee were treated by 3 surgical strategies in the acute phase. (1) One-stage: Twelve patients treated by repair and reconstruction of all ruptured ligaments in a single operation. (2) Staged: Eleven patients treated by repair or reconstruction of the extraarticular (EA) ligaments and then intraarticular ligaments in 2(nd) stage. (3) EA ligament repair: Nine patients underwent only EA ligaments repair.
  
  
  RESULTS
  The patients were followed up for an average of 34.7 ± 12.1 months. Significant improvements in knee stabilities (P < 0.01), Lysholm score (P < 0.01) and International Knee Documentation Committee grade (P < 0.01) were noticed in all groups. Of the 32 patients, none had gross mal alignment or gait abnormalities at the latest followup. Comparing the 3 groups, a significant difference in Lysholm score was shown between the one stage group and the EA repair group (P = 0.040); additionally, significant differences were found in 2 subscales of knee injury and osteoarthritis outcome score (P < 0.05).
  
  
  CONCLUSIONS
  Satisfactory clinical and functional outcomes could be achieved adopting the 3 surgical strategies based on personalized treatment. However, a combination of EA repair and intraarticular repair or reconstruction might be more reasonable options for the young and active patients.
authors.affiliation: Orthopaedic Center of PLA, The 88 Hospital of PLA, Tai'an City, Shandong Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Sun
authors.affiliation: Orthopaedic Center of PLA, The 88 Hospital of PLA, Tai'an City, Shandong Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Wu
authors.affiliation: Orthopaedic Center of PLA, The 88 Hospital of PLA, Tai'an City, Shandong Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Tian
authors.affiliation: Orthopaedic Center of PLA, The 88 Hospital of PLA, Tai'an City, Shandong Province, China.
authors.forename: Yong Zhong
authors.initials: YZ
authors.lastname: Luo
keywords: ACL reconstruction; Arthroscopy; Knee joint; anterior cruciate ligament; arthroscopic surgical procedures; arthroscopy; knee; knee dislocation; multiple ligament injury; surgical management