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