Multiligament knee injuries and gait analysis

Background: Multiligament knee injuries (MLKI) are complex, potentially limb-threatening conditions involving the disruption of at least two major stabilizing structures. Despite the prevalence of multiligament knee reconstruction (MLKR) to restore mechanical stability, significant heterogeneity in injury patterns and recovery potential persists. Current clinical challenges include determining optimal surgical timing, graft selection, and the balance between postoperative joint stability and arthrofibrosis.

Objective: This study aims to characterize the demographics and clinical outcomes of an MLKI cohort and utilize three-dimensional gait analysis to evaluate functional recovery and spatiotemporal adaptations following reconstructive surgery.

Key Points: Analysis of 165 patients revealed a mean age of 32.4 years, with a 18.9% incidence of peroneal nerve injury. Postoperative functional scores remained below population norms, with a mean subjective IKDC score of 70.5. Gait analysis of 16 MLKR patients compared to matched controls demonstrated significant alterations, including reduced walking velocity, shorter step length, and increased initial double support time. Kinematic data indicated decreased arcs of motion in sagittal, frontal, and transverse planes during the early stance phase. Regression modeling identified that flexion contractures and medial collateral ligament involvement were more strongly associated with pathological gait patterns than residual anterior tibial laxity.

Conclusion: MLKR effectively restores gross stability, yet functional gait abnormalities persist postoperatively. Clinical outcomes are more adversely affected by postoperative joint stiffness and extension deficits than by minor residual laxity. These findings suggest that rehabilitation protocols should prioritize the early restoration of joint mobility to optimize long-term functional gait characteristics.