Multiligament Injury of the Knee. First Intrarticular or Posterior

OBJECTIVES: Show our experience about the multiligament injury of the knee. In the surgical technique it is most popular and recommended stabilized first all posterior and lateral (Ligament cruciate Posterior (LCP) and postero-lateral corner) if is a case. We show our experience stabilized first all intra-articular ACL and LCP. METHODS: Prospective study and Case Series. The study includes, 45 cases in 15 years of experience. The patients have two or more ligaments with rupture, and associated lesions, like meniscus, cartilages, fractures, etc. 45 cases with a ACL rupture, 40 PCL, 7 posteromedial corner, 25 postero-lateral corner, 30 meniscus medial, 28 meniscus lateral, 1 vascular lesion, and 3 fibular nerve. In the surgical technique always use autograft. Prefer hamstrings, quadricipital tendon, contralateral hamstrings, BTB and sometimes peroneus brevis. We hope 1 or 2 weeks for the surgery. I never use pump, and use tourniquet for two hours. We start for the meniscus lesions and cartilage lesion and first reconstruction ligaments intra-articular. Finalized we open the tourniquet and stabilized the postero-lateral o posteromedial corner if is necessary. In the first cases we did a surgery in two times, but now we stabilized in one surgical time. RESULTS: 3 to 6 days in the hospital 2 weeks immobilized and star rehabilitation with brace for more two weeks. Use crutches for 4-6 weeks. Worked in rehabilitation for a one year and star competition in one year. Complications: 1 case of amputation for vascular lesion, 9 arthrofibrosis, 2 medial instability, 1 lateral instability and1 LCP instability. One case needs a revision two years after the first surgery, for a new trauma in the work. All other cases had a new surgery for revision the residual instability. CONCLUSION: The multiligament injury of the knee it is not frequently, but every year I receive more cases, and more difficult. In the surgical technique have two options. The more recommended stabilized first all posterior (LCP and postero-lateral corner). Our experience shows no difference in these two options.