Multiligament knee surgical planning checklist: Introducing a conceptual shift in the reporting of surgical management protocols with mid-term outcomes

Background: Multiligament knee trauma is a heterogenous and exceptionally challenging area of knee-preserving surgery. Currently, there is a lack in reporting standards of treatment protocols and outcomes. The aim of this study is to present a novel way for reporting multiligament injury management protocols with their outcomes which could become a basis for future standardization. Methods: To address acute multiligament knee injury management, a lesion-specific surgical planning checklist was developed. Patients managed according to the checklist were evaluated at 4.5- to 10-year follow-up incorporating reported and disease-specific outcome scores alongside knee function measures. Descriptive statistics included means with standard deviations and medians with ranges. Tegner activity level at follow-up was compared to before the injury. Statistical significance threshold was set at 0.05. Results: Of 25 patients with multiligament injured knees treated between 2013 and 2020, the checklist was applicable to 17, which were managed early (i.e., within 3 weeks), of whom 15 were managed in accordance with the checklist items. Of these, 12 were evaluated at mid-term (12/15 = 80% follow-up rate). The follow-up International Knee Documentation Committee –subjective score was 75 ± 14, the Knee injury and Osteoarthritis Outcome Score-symptoms was 74 ± 17, KOOS-activities of daily living was 85 ± 15, KOOS-sports was 60 ± 28, the multiligament quality of life questionnaire–physical impairment score was 31 ± 20, and jump–squat performance was found symmetric in 75%. Tegner activity level was inferior compared to before the injury (median 4 vs. 7, p = 0.02). No infections, iatrogenic neurovascular injuries, or thromboembolic events were encountered in any of the 25 patients. Conclusion: A lesion-specific 20-item checklist designed for surgical planning in acute multiligament knee trauma clearly defines the surgical protocol, facilitates the preparations for surgery, and is associated with favorable mid-term outcomes. Nevertheless, a multicenter collaboration is still required in order to transform this reporting method into a validated global registry system. Level of evidence: 4, Case series.