Outcomes of Operative Management of Multi-Ligament Knee Injuries in an Adolescent Population: A Retrospective Case Series Original Research

Abstract

Background: The aim of this study was to describe the presentation, surgical management, and patient outcomes following multi-ligament knee injuries in a pediatric and adolescent cohort.

Methods: A retrospective case series was conducted involving all patients aged <18 years who underwent surgery for a multi-ligament knee injury at a single institution between March 2005 and January 2015. Outcome questionnaires were administered, including Pediatric version of International Knee Documentation Committee (Pedi-IKDC), Lysholm score, Tegner activity scale, and an internal physical activity questionnaire.

Results: Twenty-three knees from 23 patients were included with a mean (SD) age of 16.4 (± 2.3) years at time of injury. The most commonly injured structure requiring reconstruction or repair was the anterior cruciate ligament (91%), the medial collateral ligament (57%), posterior cruciate ligament (22%), posterolateral corner (22%), and lateral collateral ligament (15%). Meniscal procedures were performed concurrently in 65% knees. Subsequent manipulation under anesthesia and arthroscopic lysis of adhesions was performed in five (22%) knees. Examination at final follow-up, occurring at a median of 20.1 months, demonstrated 100%  knees could achieve full extension and 87% could achieve full flexion. Questionnaires were returned by 12 patients (52%) at a median of 3.7 years post-operatively. The mean Pedi-IKDC, Lysholm, and Tegner scores were 81.0  18.1, 82.5  15.5, and 8.3, respectively.

Conclusions: In this study, multiligament knee injuries in children and adolescents resulted mainly from sports-related injuries. Patients were generally able to achieve good functional outcomes at short term follow-up and return to sport was possible.