Decision Making in the Multiligament-Injured Knee: An Evidence-Based Systematic Review

Levy, Bruce A.; Dajani, Khaled A.; Whelan, Daniel B.; Stannard, James P.; Fanelli, Gregory C.; Stuart, Michael J.; Boyd, Joel L.; MacDonald, Peter; Marx, Robert G.

doi:10.1016/j.arthro.2009.01.008

Cited by 415 publications

(450 citation statements)

References 38 publications

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“…Recent evidence suggests an incidence of 0.072 events per 100 patient-years [2]. Although this is substantially higher than the previously reported incidence of 0.001 events per 100 patient-years in the general population and 0.0125 events per 100 patient-years within orthopaedic injuries, it is still very low [14,18]. Because multiligament injuries often reduce spontaneously, the actual incidence may be slightly higher as a result of missed diagnoses [1][2][3][4]9].…”

Section: Introductionmentioning

confidence: 85%

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Epidemiology of Multiligament Knee Reconstruction

Wilson

Mehta

Hương

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The multiple-ligament-injured knee represents a special challenge, being an uncommon injury that is both severe and complicated to treat. Many studies have evaluated patients treated for this injury, but most are limited in their scope. The evaluation of this injury and its treatment using an administrative database might provide a different perspective.Questions/purposes Using a large administrative database, we determined (1) the number of multiligament knee reconstructions in New York State, (2) the rate of 90-day hospital readmission, and (3) the frequency of subsequent knee surgery. We examined the rates of these outcomes as a function of diagnosis, admission type, discharge status, comorbidity burden, and patient demographic factors. Methods We used the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS), a database with information on patient characteristics, diagnoses, and treatments, to identify patients who underwent a multiligament procedure in a nonfederal facility from 1997 to 2005 using ICD-9-CM and Current Procedural Terminology codes. SPARCS collects data from all nonfederal acute care facilities, with an estimated reporting completeness of almost 99% for the years in this study. We evaluated data on patient age, sex, admission type, discharge status, and comorbidity burden (using Elixhauser comorbidities) and developed a multivariable logistic regression model to assess the influence of confounding variables. Results We identified 1032 patients in this database who underwent multiligament knee reconstruction in New York State from 1997 to 2005. The frequency of readmission within 90 days was 4.8% (n = 49). Readmission was more likely for patients who underwent inpatient multiligament reconstruction (odds ratio [OR] = 2.3; 95% CI: 1.2-4.4; p = 0.014), had a diagnosis of dislocation (OR = 2.2; 95% CI: 1.2-3.9; p = 0.011), or had various Elixhauser comorbidities, including chronic lung disease (OR = 6.4; 95% CI: 1.5-27.2; p = 0.013), fluid and electrolyte disorders (OR = 19.7; 95% CI: 2.5-155.7; p = 0.005), and anemia deficiency (OR = 5.6; 95% CI: 1.05-29.4; p = 0.044). Two hundred eighty-seven patients (28%) underwent subsequent knee surgery between their index

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Section: Introductionmentioning

confidence: 85%

“…The evidence supporting management of the multiligament-injured knee is limited mostly to case series [9,18,24,25]. This is primarily because its low incidence makes it inherently difficult to evaluate treatments with large, prospective clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Multiligament Knee Reconstruction

Wilson

Mehta

Hương

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Historically, most authors have recommended securing the PCL graft first at 708 to 908 of knee flexion to obtain appropriate reduction of the tibio-femoral articulation, followed by ACL graft fixation in full extension to ensure the ability of the knee to reach full extension [1,2,4]. Because most surgeons are more fearful of PCL failure and subsequent revision, as opposed to ACL failure, fixing the PCL first theoretically should protect the PCL graft.…”

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CORR Insights®: Does Sequence of Graft Tensioning Affect Outcomes in Combined Anterior and Posterior Cruciate Ligament Reconstructions?

Levy

2015

Clinical Orthopaedics &Amp; Related Research

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“…In cases of symptomatic laxity of the medial side of the knee, posteromedial corner anatomic reconstruction of the superficial MCL with or without reconstruction of the POL using soft-tissue grafts, bone sockets, and interference screw fixation has shown good biomechanical results. 3,4 However, autografts have morbidity, allografts have risks, 2 and bone tunnels with interference screws sacrifice bone stock, which may be of particular concern for multiligament reconstructive cases.…”

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confidence: 99%

“…1,2 The relevant anatomic structures that contribute to posteromedial knee stability include the superficial and deep medial collateral ligaments (MCLs), the posterior oblique ligament (POL), and the semimembranosus. In cases of symptomatic laxity of the medial side of the knee, posteromedial corner anatomic reconstruction of the superficial MCL with or without reconstruction of the POL using soft-tissue grafts, bone sockets, and interference screw fixation has shown good biomechanical results.…”

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confidence: 99%

Knee Medial Collateral Ligament and Posteromedial Corner Anatomic Repair With Internal Bracing

Lubowitz¹,

Mackay²,

Gilmer³

2014

Arthroscopy Techniques

115

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An internal brace is a ligament repair bridging concept using braided ultrahighemolecular-weight polyethylene/polyester suture tape and knotless bone anchors to reinforce ligament strength as a secondary stabilizer after repair and return to sports, which may help resist injury recurrence. An internal brace may provide augmentation during knee medial and posteromedial corner anatomic repair. In patients with combined, chronic, symptomatic anterior cruciate ligament (ACL)eposteromedial corner laxity, combined ACL reconstruction with posteromedial corner reconstruction is indicated. Our ACL technique was previously published with video illustration in Arthroscopy and Arthroscopy Techniques. The purpose of this article is to describe, with video illustration, knee posteromedial corner reconstruction using anatomic repair with internal brace augmentation.

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Decision Making in the Multiligament-Injured Knee: An Evidence-Based Systematic Review

Cited by 415 publications

References 38 publications

Epidemiology of Multiligament Knee Reconstruction

Epidemiology of Multiligament Knee Reconstruction

CORR Insights®: Does Sequence of Graft Tensioning Affect Outcomes in Combined Anterior and Posterior Cruciate Ligament Reconstructions?

Knee Medial Collateral Ligament and Posteromedial Corner Anatomic Repair With Internal Bracing

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