Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2015; 6(3): 363-368
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.363
Multiligament knee injuries with associated tibial plateau fractures: A report of two cases
Vani J Sabesan, Paul J Danielsky, Abby Childs, Tom Valikodath
Vani J Sabesan, Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, MI 48124, United States
Vani J Sabesan, Paul J Danielsky, Abby Childs, Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, United States
Tom Valikodath, Michigan State University College of Human Medicine, Grand Rapids, MI 49503, United States
Author contributions: Sabesan VJ designed the report; Sabesan VJ, Danielsky PJ, Childs A and Valikodath T collected the patient clinical data and wrote the manuscript.
Ethics approval: The study was reviewed by and received exemption from the Borgess Medical Center Institutional Review Board.
Informed consent: Both patients have provided written informed consent supporting their inclusion in this case report.
Conflict-of-interest: All authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Vani J Sabesan, MD, Department of Orthopaedic Surgery, Wayne State University School of Medicine, 10000 Telegraph Road, Taylor, Detroit, MI 48124, United States.
Telephone: +1-313-3757218
Received: November 8, 2014
Peer-review started: November 17, 2014
First decision: December 26, 2014
Revised: January 31, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: April 18, 2015

The management of a combination of fracture and multiligament knee injury (MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI’s in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI’s with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Keywords: Multiligamentous knee injuries, Tibial plateau fracture, Knee dislocation, Surgical fixation, Treatment algorithm, Conservative treatment

Core tip: Extensive review of the literature illustrates the limited evidence on these types of complex knee injuries. Patients with multiligament knee injury (MKI) and tibial plateau fractures require a complex treatment algorithm optimized to patient specific injuries and expectations. We propose an algorithm for treating MKI with concomitant fracture in middle aged-patients.