4. What is the Current Standard of Care for a Multi-Ligament Knee Injury?
The current standard care for a multi-ligament knee injury is to operate earlier rather than later, to perform reconstructions rather than repairs for the main static stabilizers and to start physical therapy with early range of motion as soon as possible (preferably on postoperative day one). While these anatomic-based surgical principles may seem simple, they were only universally advocated as the standard of care within the last three years. In contrast, our group has advocated this approach for almost 20 years, and our publications have documented that our clinical outcomes are superior to returning patients back to high levels of activity when these protocols are followed compared to some of the older protocols.
Thus, early surgery with anatomic-based and biomechanically validated reconstructions of the ACL, a double bundle PCL, an MCL with or without a posterior oblique ligament repair or reconstruction, and a posterolateral corner reconstruction, which can be either an anatomic reconstruction of the FCL/LCL or a complete posterolateral corner reconstruction, are able to restore stability to the knee, allow for early and safe range of motion, and provide significantly improved outcomes for these patients.
We have found that overall even though these injuries are often quite severe, in the vast majority of cases where they are treated with these principles, we were able to restore the patients back to functioning levels seen historically with isolated ACL reconstructions. A review of our many papers looking at quantitative anatomy, improved ways to diagnose these injuries, new biomechanical studies based on the redefined anatomy, and the development of anatomic-based reconstructions for the ACL, PCL, posterolateral corner, MCL, proximal tibiofibular joint, popliteus tendon and multiple variants of meniscus repairs are located within the research section of our website so that one can see these new publications. Almost all of them are published in the highest impact orthopedic journals, which helps to validate many of our procedures. In addition, the banners on several of these high level peer review publications note which ones were selected by our peers as nationally and internationally-based research award winners because of the novel and new approach to treating these pathologies.