Reconstruction of the Anterior and Posterior Cruciate Ligaments After Knee 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 pro tected knee motion after knee dislocations (seven acute and four chronic). Six patients had concurrent repair or reconstruction of medial ligamentous struc tures, and six had reconstruction of the lateral and posterolateral ligaments. All patients returned for fol lowup at a mean of 4.8 years postoperatively. Fol low-up arthrometric testing at 20° of flexion showed 10 knees had less than 3 mm of increased total anterior- posterior displacement and 1 knee had 7 mm of in crease. At 70° of flexion, 9 knees had less than 3 mm of increased displacement and 2 knees had more than 6 mm of increase. The failure rates were as follows: 18% of posterior 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 followup, five of the seven patients with acute injuries had no limitations with daily or sports activities. Three of the four patients with chronic ruptures were asymp tomatic with daily activities, but only one was asymp tomatic with light sports. Five patients (all acute inju ries) required treatment for knee motion limitations. Nine patients had full range of motion at followup. We concluded that simultaneous bicruciate ligament re constructions, performed with associated medial or lat eral procedures, are warranted to restore function to all ligament structures. Even though immediate motion was used, several patients required early manipulation or arthroscopic debridement, which restored full motion and prevented permanent arthrofibrosis.