A 23-year-old recreational player presented following an acute injury to his left knee. He described sustaining a significant valgus stress to his knee. There was immediate pain, rapid swelling and a marked sense of instability. On examination he was found to have gross laxity with a valgus stress (both in flexion and in extension) and laxity with Lachman’s test.
An x-ray series of the knee showed an effusion, but no bony injury. MRI images show a complete rupture of both the anterior cruciate and medial collateral ligaments. The posterior cruciate ligament is also ruptured with marked deformity and an amorphous appearance in the intercondylar notch. The lateral collateral ligament complex also appears amorphous, but is intact. It has increased signal intensity consistent with ligamentous sprain. Other MRI images show a complex tear of the lateral meniscus and bony impaction injuries.
The player had surgery to repair his PCL and MCL injuries. He then underwent a second procedure to reconstruct his ACL. Three months following the second procedure he is progressing well with a gym-based programme.
Multi-ligament knee injuries (MLKI) are complex with many variables involved in outcome statistics. As a result, return to play rates vary. A systematic review evaluated rates of return to work or sport after MLKI as well as risk factors that might result in a patient being unable to return to work or sport after MLKI.1. The review included a total of 524 patients and 21 individual studies. While the recorded return to play rates was approximately 60% for surgically managed MLKI, return to play at a similar level of sport was much lower. Return to play rates of only 22% were recorded for ‘competitive’ athletes and 33% for ‘elite’ athletes. An elevated BMI, pursuing non-operative treatment, a higher injury severity and a coexisting vascular injury also appear to be associated with poorer functional outcomes.
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