Clinical Outcome of Bicruciate Ligament Reconstruction in Multiple-Ligament Knee Injuries: Comparison With Bicruciate Reconstruction and Collateral Ligament Surgery.

Abstract

Background: Several procedures for combined rupture of both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in multiple-ligament knee injuries (MLKIs) have been reported. However, the clinical outcome of these treatments remains controversial.

Hypothesis: Postoperative knee stability and clinical outcomes in patients who underwent simultaneous bicruciate reconstruction would be comparable with those that underwent bicruciate reconstruction with collateral ligament surgery.

Study design: Cohort study; Level of evidence, 3.

Methods: A retrospective study was conducted with 41 patients (41 knees) who sustained unilateral MLKI with combined ACL and PCL rupture. Fifteen cases required simultaneous ACL and PCL reconstruction, and the others had additional surgical treatment as follows: At the time of cruciate ligament reconstruction, 14 cases required posteromedial corner (PMC) reconstruction and 8 cases required posterolateral corner (PLC) reconstruction. Five cases were treated with an initial PMC or PLC before the cruciate ligament reconstruction. One of these underwent PMC reconstruction at the second stage for residual valgus laxity. Then, the authors divided the cases into 2 groups based on surgical procedure: in group 1, 15 patients underwent only bicruciate reconstruction. In group 2, 26 patients underwent bicruciate and PMC or PLC reconstruction/repair. The patients were examined at ≥2 years after surgery.

Results: The side-to-side difference in the total anteroposterior translation, and the relative position on the anterior and posterior stress radiographs significantly improved postoperatively in both groups (group 1: P = .0115, P = .0007; group 2: P = .0004, P < .0001). In the valgus and varus stress tests, the medial and lateral joint opening significantly improved postoperatively in group 2 (P < .0001; P = .0093). Anterior, posterior, valgus, and varus stress radiographs showed no significant differences in comparison with that in the uninjured knee. There were no significant differences in the postoperative anteroposterior laxity and the medial and lateral joint opening between the groups. The Lysholm score, the International Knee Documentation Committee evaluation, all subscales of the Knee injury and Osteoarthritis Outcome Score, the Tegner score, and the isokinetic peak torque of quadriceps and hamstring muscles significantly improved postoperatively in both groups (P < .0003). Each clinical parameter did not differ between the 2 groups.

Conclusion: There were no significant differences in the knee stability and clinical results after bicruciate reconstruction between those with and those without collateral ligament surgery. Reconstruction of bicruciate MLKIs with repair or reconstruction of associated collateral ligament injuries improves clinical outcomes.