Comparative evaluation of single-stage and two-stage reconstruction in multiligament knee injuries: A retrospective comparative study

Objective: to evaluate clinical and functional outcomes of different surgical approaches in patients with multiligamentous knee injuries (MLKI) classified as Schenck type III (III‑L and III‑M).

Materials and methods. A retrospective comparative study included 43 patients with chronic knee instability following Schenck type III MLKI. Based on the surgical intervention performed, patients were divided into three groups: single‑stage reconstruction of the anterior and posterior cruciate ligaments (ACL + PCL) without posterolateral corner (PLC) repair; single‑stage reconstruction of the ACL + PCL with PLC repair; and a two‑stage reconstruction group, where the first stage involved PCL and PLC reconstruction, followed by ACL reconstruction 6 months later. Outcomes were evaluated using IKDC and Lysholm scores, as well as stress radiography results.

Results. The two‑stage approach (Group 3) demonstrated significantly better outcomes according to IKDC and Lysholm scores (p < 0.01), improved stability on stress radiographs, and lower complication rates. Notably, 4 patients from Group 3 declined ACL reconstruction due to satisfactory functional recovery after the first stage.

Conclusion: The study findings demonstrate that for chronic multiligament knee injuries (Schenck type III), a two‑stage surgical strategy offers superior outcomes compared to single‑stage interventions. Staging the reconstruction of posterior and anterior structures not only improves functional scores and joint stability but also prevents excessive surgical trauma. Notably, satisfactory functional restoration is achieved in some patients after the first stage (PCL and PLC reconstruction) alone, rendering the second stage unnecessary. Therefore, a personalized two‑stage approach is the preferred strategy, ensuring optimal clinical results and high patient satisfaction.

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