RECONSTRUCTION OF THE ANTERIOR AND POSTERIOR CRUCIATE LIGAMENTS AFTERKNEE DISLOCATION - USE OF EARLY PROTECTED POSTOPERATIVE MOTION TO DECREASE ARTHROFIBROSIS

We report a critical rating of results for 11 patients with bicruciate ligament reconstructions and immediate protected knee motion after kn ee dislocations (seven acute and four chronic). Six patients had concu rrent repair or reconstruction of medial ligamentous structures, and s ix had reconstruction of the lateral and posterolateral ligaments. All patients returned for followup at a mean of 4.8 years postoperatively , Follow-up arthrometric testing at 20 degrees of flexion showed 10 kn ees had less than 3 mm of increased total anterior-posterior displacem ent and 1 knee had 7 mm of increase. At 70 degrees of flexion, 9 knees had less than 3 mm of increased displacement and 2 knees had more tha n 6 mm of increase, The failure rates were as follows: 18% of posterio r cruciate ligament reconstructions (2 of 11), 9% of anterior cruciate ligament reconstructions (1 of 11), 17% of lateral and posterolateral procedures, and 0% of medial collateral ligament procedures, At follo wup, five of the seven patients with acute injuries had no limitations with daily or sports activities. Three of the four patients with chro nic ruptures were asymptomatic with daily activities, but only one was asymptomatic with light sports. Five patients (all acute injuries) re quired treatment for knee motion limitations. Nine patients had full r ange of motion at followup. We concluded that simultaneous bicruciate ligament reconstructions, performed with associated medial or lateral procedures, are warranted to restore function to all ligament structur es, Even though immediate motion was used, several patients required e arly manipulation or arthroscopic debridement, which restored full mot ion and prevented permanent arthrofibrosis.