Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 2, pp 445–459 | Cite as

Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries

  • Eduard Alentorn-Geli
  • Alexander L. Lazarides
  • Gangadhar M. Utturkar
  • Heather S. Myers
  • Kristian Samuelsson
  • J. H. James Choi
  • Joseph J. Stuart
  • Claude T. MoormanIIIEmail author



To investigate the influence of injury and treatment factors on clinical/functional outcomes in multiligament knee injuries (MLKI).


Thirty-nine consecutive patients with confirmed and surgically treated MLKI who met inclusion criteria were scheduled for a follow-up visit to obtain: SF-12 and subjective feeling of normalcy between the operated and healthy knee, and IKDC, active range of motion (ROM), and stability exam (Lachman test, posterior drawer, and dial test at 30°). A chart review was used to obtain data on injury and treatment factors.


The postoperative mean (SD) outcomes were: IKDC score 62.7 (25.9), flexion–extension ROM 125° (29°), and percentage of normalcy 74% (20%). The postoperative normal/nearly normal stability exam was: Lachman test 36 (95%) patients, posterior drawer at 90° 38 (97%) patients, and dial test of 39 (100%) patients. There were 24 (61.5%) and 23 (59%) patients with complications and reoperations, respectively. The presence of bicruciate injuries was associated with worse Lachman (p = 0.03) and posterior drawer tests (p = 0.03). Presence of injury to meniscal structures was associated with worse Lachman test (p = 0.03), lower percentage of normalcy (p = 0.02) and extension lag (p = 0.04). Injury to cartilage structures was associated with worse IKDC scores (p = 0.04). IKDC was lower in cases of posterolateral corner reconstruction (p = 0.03) and use of allograft tendons for reconstruction (p = 0.02); ROM was lower in allograft reconstruction (p = 0.02) and need for meniscal repair (p = 0.01). Bicruciate reconstruction led to worst posterior drawer test (p = 0.006).


The outcomes of MLKI might be negatively influenced by bicruciate ligament, meniscal, and cartilage injuries; with regards to treatment characteristics, need for posterolateral corner or bicruciate ligament reconstruction, use of allografts, or need for meniscal repair may similarly diminish outcomes. While surgical treatment provides good overall function, ROM and stability, it rarely results in a “normal” knee and the chances of complications and reoperations are high.

Level of evidence

Cross-sectional comparative study, Level III


Multiligament knee injuries Outcomes Diagnostic Injury Treatment 



This study was not funded.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest that directly relate to this manuscript.

Ethical approval

This study was approved by our institutional review board and all patients enrolled in accordance with approved IRB protocol.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Eduard Alentorn-Geli
    • 1
    • 2
    • 3
    • 4
  • Alexander L. Lazarides
    • 1
  • Gangadhar M. Utturkar
    • 1
    • 5
  • Heather S. Myers
    • 6
  • Kristian Samuelsson
    • 7
    • 8
  • J. H. James Choi
    • 1
  • Joseph J. Stuart
    • 1
  • Claude T. MoormanIII
    • 1
    • 9
    Email author
  1. 1.Department of Orthopaedic Surgery, Duke Sports Sciences InstituteDuke UniversityDurhamUSA
  2. 2.Fundación García-CugatBarcelonaSpain
  3. 3.Artroscopia GC, S.L.BarcelonaSpain
  4. 4.Mutualidad Catalana de Futbolistas, Federación Española de FútbolBarcelonaSpain
  5. 5.Department of Biomedical EngineeringDuke UniversityDurhamUSA
  6. 6.Department of Physical TherapyDuke UniversityDurhamUSA
  7. 7.Department of OrthopaedicsSahlgrenska University HospitalMölndalSweden
  8. 8.Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  9. 9.Deparment of Orthopaedic SurgeryOrthoCarolina, Atrium HealthCharlotteUSA

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