Multistage Reconstructions of Multi-ligamentous Injury in Arthrofibrosis Knee: a Case Report.

Abstract

Multiligamentous knee injuries occur as a result of both high- and low-energy trauma to the knee, most commonly due to motor vehicle accidents and sports-related injuries. Commonly reported complications after multi-ligament knee reconstruction include wound infection, deep venous thrombosis (DVT), and arthrofibrosis. A 42-year-old female was struck by a motor vehicle and suffered pain and swelling in her left knee. The patient was ambulated using a wheelchair. She underwent debridement and a synovial fluid evacuation procedure. An MRI examination and arthroscopy revealed arthrofibrosis and multi-ligamentous injury in her left knee. Arthroscopic debridement was performed, and the evaluation of the knee showed a multi-ligamentous injury. Ligament reconstruction was performed and produced a favorable outcome in terms of range of motion.Arthrofibrosis causes knee symptoms during walking and standing, and the condition is frequently more debilitating than the original injury or degenerative condition. Even a small loss of knee extension of 5 results in difficulty walking, while a loss of flexion creates problems with stair climbing, sitting, getting in and out of chairs and cars, and driving. Post-operative fibrosis of the knee is defined as a limited ROM in extension and/or flexion. Arthrofibrosis is classified as mild, moderate, and severe. Staged surgery consists of acute primary repair of collateral ligaments with cruciate reconstruction once improved range of motion has been obtained, and good outcomes have been reported for range of motion and stability. Conditions that play a role in the development of arthrofibrosis include acute ACL reconstruction, late rehabilitation, and meniscus injury. Arthroscopic debridement plays a pivotal role in the management of arthrofibrosis.