Right Knee Injury - Landscaping

HISTORY: A 35 year old male who works for a tree trimming service presented to the clinic two days after a tree branch fell on his right knee. He was unable to bear weight and denied any previous knee injury. PHYSICAL EXAMINATION: Examination of the right knee revealed a large effusion about the knee joint, ecchymosis over the anterior knee, positive Lachman exam, positive anterior and posterior drawer exam, stability to varus stress, and increased valgus laxity opening 3 mm medially. Motor was intact GS/TA/EHL/FHL. Sensation was intact to light touch in deep peroneal, superficial peroneal, tibial, sural, and saphenous distributions. Palpable pedal pulses. ROM of the knee was 15-80 degrees. DIFFERENTIAL DIAGNOSIS: 1.Multiligamentous knee injury 2.Right knee patella dislocation 3.Tibial plateau fracture TEST AND RESULTS: XR KNEE <3 VW RIGHT, TIBIA FIBULA 2 VW RIGHT, FEMUR 2 VW RIGHT - Lateral femoral condylar and tibial plateau fractures with questionable medial patellar fracture CT KNEE RIGHT WO CONTRAST - Comminuted displaced fractures of the posterior central tibial plateau, lateral femoral condyle, and medial patella with one of the fracture fragments of the tibial plateau completely rotated 180 degrees directed inferiorly towards the fracture margin. MRI RIGHT KNEE - ACL/PCL tears with avulsions of the tibial spines. Complete rupture of MCL. MPFL rupture. Osseous avulsions of popliteus and LCL without displacement, chronic appearance to popliteus bony injury. FINAL DIAGNOSIS: Right knee multiligamentous knee injury - ACL, PCL, MCL, tibial plateau fracture, medial/lateral meniscus root avulsions, tibial spine loose osteochondral fragments TREATMENT AND OUTCOMES: 1. Single stage right knee arthroscopic ACL reconstruction, PCL repair, tibial plateau ORIF, MCL reconstruction, medial and lateral meniscus root repair. 2. Non-weight bearing for 6 weeks with hinged knee brace for 3 months. Early passive ROM encouraged at time 0, with referral at 2 weeks emphasizing full ROM. 3. Full weight bearing and formal strengthening at 6 weeks post op. Achieved 0-90 ROM week 12 at which point his progress plateaued. 4. Underwent lysis of adhesions 5 months post op and achieved a final ROM 0-120. 5. Returned to work at 7 months without the use of brace and complained of no instability in the knee.