Article Text

Download PDFPDF
Primary repair of multiligament knee injury with InternalBrace ligament augmentation
  1. Paul Andre Paterson-Byrne1,
  2. William Thomas Wilson2,
  3. Graeme Philip Hopper2 and
  4. Gordon M MacKay3
  1. 1Trauma & Orthopaedics, Health Education England, Sunderland, UK
  2. 2Trauma & Orthopaedics, NHS Greater Glasgow and Clyde, Glasgow, UK
  3. 3Orthopaedics, Rosshall Hospital, Glasgow, UK
  1. Correspondence to William Thomas Wilson; william.wilson{at}


Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.

  • knee injuries
  • orthopaedics
  • knee laxity

Statistics from


  • Twitter @DrWilliamWilson

  • Contributors PAP-B and WTW prepared the manuscript. GPH and GMM reviewed and amended the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests GMM is a paid consultant for Arthrex, whose products were used in this case.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.