Results of restoration of complex injuries in ligamentous apparatus of the knee joint

Maksim Golovakha, Oleg Banit, Rostyslav Titarchuk, Igor Zasypko, Inna Didenko, Weniamin Orljanski


Injuries of multiple ligaments of the knee joint usually occur as a result of high energy trauma. The greatest difficulties one has in choice of tactics in treatment of patients with combined injuries of capsular and ligamentous apparatus of the knee joint.

Objective: To determine the most appropriate treatment strategy for patients with complex injuries of the ligaments of the knee joint.

Methods: We studied 37 patients (31 men, and 6 women aged 24 to 44 years) with two or more ligaments injuries of the knee joint of varying severity as a result of sport (12) and road traffic (25) injuries. We discovered combined injuries of ligaments: anterior crucial ligament (ACL) and medial collateral — 12; posterior crucial ligament (PCL) and medial collateral — 3; ACL, PCL and both collateral — 15; PCL and lateral collateral — 7. All patients were treated surgically. The outcomes were evaluated in 4 and 6 months after the operation according to scale IKDC and MRI parameters.

Results: The most severe injuries are luxations of the shin accompanied by injuries of two crucial ligaments and one or two collateral ligaments. In this case restorative surgical treatment of all damaged structures can be made in the first day after trauma. But due to technical difficulties conservative waiting tactics with staged restoration of ligaments is justified. In the case of fresh or inveterate injury of ACL and PCL it is possible to perform their simultaneous and staged recovery when firstly they restore PCL, and after 3–4 months — ACL. The best results of PCL reconstruction are obtained in case surgical treat­ment immediately after the injury. Along with the reconstruction of PCL it is necessary to restore posterolateral capsular-ligamentous complex. The combined damages of the medial collateral ligament and one of the crucial ligaments rarely need to restore medial capsular-ligamentous structures. Under condition of restoration of fresh ACL injury almost always they eliminate instability caused by medial collateral ligament injury. In another case after fresh injury it is necessary to perform suturing of disruption place and after inveterate — plasthy of medial part of the knee joint.


knee joint; crucial ligaments; surgical treatment


Bolhovitin P. V. Cruciate Ligaments Reconstruction in a System Knee Instability Surgery, dis ... Sciences: 14.01.21 / Institute of Spine and Joint named by Sitenko of Ukraine Academy of Medical Sciences — Kharkiv, 2005.

Zazirnyy I. M. Biomechanics of the knee joint with defect of posterior cruciate ligament (review diteratury) / I. M. Zazirnyy // Herald of Orthopedics and Trauma and Prosthetics . — 2014. — № 4. — P. 73–79.

Linko Y. V. Post-traumatic posterior instability of the knee joint (clinical and experimental study). — Dissertation ... Kyiv. — 2003. 127 p.

Results of modeling knee ligament injuries/ M. Y. Karpynskyy, E. D. Karpynskaya, R. A. Schykota, A. A. Tyazhelov, L. D. Goncharova // Injury. — 2012. — Volume 13 № 3. — P. 1645.

The results of surgical treatment of acute injuries — tibial collateral ligament rupture, combined with partial injury of the anterior cruciate ligament / V. G. Klymovytskyy, R. A. Schykota, L. D. Goncharova, A. A. Tyazhelov // Trauma. — 2012. — Volume 13. — № 4. — P. 7–11.

Prediction results of treatment of patients with anteromedial knee instability / S. S. Strafun, R. O. Sergienko, A. S. Strafun at al. // Orthopedics, Traumatology and Prosthetics. — 2012. — № 2. — P.64–67.

Acute grade III medial collateral ligament injury of the knee associated with anterior cruciate ligament tear. The usefulness of magnetic resonance imaging in determining a treatment regimen / N. Nakamura, S. Horibe, Y Toritsuka [et al.] // Am. J. Sports Med. — 2003. — Vol. 31. — № 2. — P. 261–267.

An in vitro analysis of an anatomical medial knee reconstruc¬tion / B. R. Coobs, C. A. Wijdicks , B. M. Armitage [et al.] // Am. J. Sports Med. — 2010. — Vol. 38. — № 2. — Р. 339–347, doi: 10.1177/0363546509347996.

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with autologous hamstring grafts-isokinetic assessment with control group / T. Piontek, K. Ciemniewska-Gorzela, A. Szulc [et al.] // PLoS One. — 2013. — Vol. 30, № 12. — Article e82462, doi: 10.1371/journal.pone.0082462.

Brown J. R. Anterior and posterior cruciate ligament injuries / J. R. Brown, T. H. Trojian // Prim Care. — 2004. — Vol. 31, № 4. — Р. 925–956.

Does sequence of graft tensioning affect outcomes in combined anterior and posterior cruciate ligament reconstructions? / S. J. Kim, S. H. Kim, M. Jung [et al.] // Clin. Orthop. Relat. Res. — 2015. — Vol. 473, № 1. — Р. 235–243, doi: 10.1007/s11999-014-3939-5.

Evaluation and treatment of acute posterolateral corner/anterior cruciate ligament injuries of the knee / G. Ross, G. P. Deconciliis, K. Choi, A. D. Scheller // J. Bone Joint Surg. Am. — 2004. — Vol. 86, Suppl. 2. — P. 2–7.

Fanelli G. C. Current concepts review. The posterior cruciate ligament arthroscopic evaluation and treatment / G. C. Fanelli, B. F. Giannotti, C. J. Edson // Arthroscopy. — 1994. — Vol. 10, № 6. — P. 673–688.

Frolke J. P. Primary reconstruction of the medial collateral liga¬ment in combined injury of the medial collateral and anterior cruciate ligaments. Short-term results / J. P. Frolke, J. Oskam, P. A. Vierhout // Knee Surg. Sports Traumatol Arthrosc. -1998. — Vol. 6, № 2. — P. 103–106.

Graft tension of the posterior cruciate ligament, using a fi¬nite element model // Y-J. Seo, Y. Song, I. S. Kim [et al.] // KSSTA. — 2014. — Vol. 22. — P. 2057–2063, doi: 10.1007/s00167-013-2609-6.

Hughston J. C. Acute anteromedial rotatory instability. Long-term results of surgical repair / J. C. Hughston, G. R. Barrett // J. Bone Joint Surg. Am. — 1983. — Vol. 65, № 2. — Р. 145–153.

Hughston J. C. The importance of the posterior oblique liga¬ment in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up / J. C. Hughston // J. Bone Joint Surg. Am. — 1994. — Vol. 76, № 9. — P. 1328–1344.

Kremchek T. E. Traumatic dislocation of the knee / T. E. Krem¬chek, R. E. Welling, E. J. Kremchek // Orthop. Rev. — 1989. — Vol. 18, № 10. — P. 1051–1057.

Larson R. L. Combined instabilities of the knee / R. L. Larson // Clin. Orthop. Relat. Res. — 1980. — Vol. 47. — P. 68–75.

Low velocity knee dislocation / K. D. Shelbourne, D. A. Porter, J. A. Clingman [et al.] // Orthop. Rev. — 1991. — Vol. 20, № 11. — P. 995–1004.

Montgomery J. B. Dislocation of the knee / J. B. Montgomery // Orthop. Clin. North Am. — 1987. — Vol. 18, № 1. — P. 149–156.

Morelli V. Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries / V. Morelli, C. Bright, A. Fields // Prim Care. — 2013. — Vol. 40, № 2. — Р. 335–356, doi: 10.1016/j.pop.2013.02.004.

Noyes F. R. The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee / F. R. Noy¬es, S.D. Barber-Westin // Am J Sports Med. — 1995. — Vol. 23, № 4. — Р. 80–89.

O’Donoghue D. H. Surgical treatment of fresh injuries to the major ligaments of the knee / D. H. O’Donoghue // Clin. Orthop. — 1991. — P. 3–8.

One-stage anatomic double bundle anterior and posterior cruci¬ate ligament reconstruction / B. Acar, K. Başarır, M. Armangil, M.S. Binnet // Int. J. Clin. Exp. Med. — 2014. — Vol. 7, № 10. — P 3710–3713.

Perryman J. R. The acute management of soft tissue injuries of the knee / J. R. Perryman, E. B. Hershman // Orthop. Clin. North Am. — 2002. — Vol. 33, № 3. — P. 575–585.

Petersen W. Combined injuries of the medial collateral liga¬ment and the anterior cruciate ligament. Early ACL reconstruc¬tion versus late ACL reconstruction / W. Petersen, H. Laprell // Arch. Orthop. Trauma Surg. — 1999. — Vol. 119, № 5–6. — Р. 258–262.

Pressman A. A review of ski injuries resulting in combined injury to the anterior cruciate ligament and medial collateral ligaments / A. Pressman, D. H. Johnson // Arthroscopy. — 2003. — Vol. 19, № 2. — P. 194–202.

Shelbourne K. D. Anterior cruciate ligament- medial collateral ligament injury: nonoperative management of medial collat¬eral ligament tears with anterior cruciate ligament reconstruc¬tion. A preliminary report / K. D. Shelbourne, D. A. Porter // Am. J. Sports Med. — 1992. — Vol. 20, № 3. — Р. 283–286.

Taylor A. R. Traumatic dislocation of the knee: a report of forty-three cases with special reference to conservative treat¬ment / A. R. Taylor, G. P. Arden, H. A. Rainey // J. Bone Joint Surg. Br. — 1972. — Vol. 54, № 1. — P. 96–102.

Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure / W. G. Clancy, K. D. Shelbourne, G. B. Zoellner [et al.] // J. Bone Joint Surg. Am. — 1983. — Vol. 65, № 3. — P. 310–322.

Copyright (c) 2015 Maksim Golovakha, Oleg Banit, Rostyslav Titarchuk, I. Zasypko, I. Didenko, Veniamin Orlyanskiy

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