Major concern in the multiligament-injured knee treatment: A systematic review

Vicenti, Giovanni; Solarino, Giuseppe; Carrozzo, M; Giorgi, Silvana De; Moretti, Luigi; Crescenzo, Angelo De; Moretti, Biagio

doi:10.1016/j.injury.2019.01.052

Cited by 42 publications

(37 citation statements)

References 35 publications

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“…According to Levy [65] and Hohmann [11], higher Lysholm and IKDC scores and satisfactory final range of motion (ROM) were found in the early surgery group. McKee et al [66] and Vicenti et al [60] also suggested the general consensus and results of early surgery in MLKI, within the first 3 weeks, and found greater ROM in the early surgery group than in the delayed surgery group [60]. The results of our analysis, including the Lysholm score, were similar to those of previous studies [4,65].…”

Section: Discussionsupporting

confidence: 89%

“…The results of our analysis, including the Lysholm score, were similar to those of previous studies [4,65]. Although other previous studies reported that a high incidence of arthrofibrosis was found in the early surgery group [26,[67][68][69], and good clinical outcomes were found in the delayed surgery group [12,55,70,71], the results of this analysis and previous systemic reviews and meta-analyses [4,60,65,66] suggest that early surgery of MLKI yields higher Lysholm scores with similar incidence of concomitant injuries and improved functional outcomes compared to delayed surgery.…”

Section: Discussionsupporting

confidence: 89%

“…However, the high risk of bias due to the low level of evidence studies was also affected by the results of clinical outcomes (Lysholm and Tegner scores), and the clinical relevances of these results are still questionable. Several previous systemic reviews and meta-analyses reported that the timing of the ACL reconstruction would not affect the outcomes [34,44,45], but other meta-analyses with high levels of evidence reported similar but somewhat superior results for early ACL reconstruction compared to delayed surgery [25,60]. Recent studies, other than meta-analyses, reported that early ACL reconstruction showed better clinical results due to rapid restoration of stability and function and less risk of meniscus and cartilage injury than delayed ACL reconstruction [24,41,42,61,62].…”

Section: Discussionmentioning

confidence: 99%

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A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries

Kim

Han

Park

et al. 2021

Knee Surg & Relat Res

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Purpose The purpose of this study was to compare clinical outcomes and incidence of concomitant injuries in patients undergoing early vs delayed surgical treatment of single anterior cruciate ligament (ACL) injury and multiligament knee injury (MLKI). Methods A literature search using PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, and Scopus from their inception to April 30, 2020 was conducted. Studies with levels I to IV evidence reporting the incidence of meniscus or cartilage injury according to early vs delayed surgery in single ACL injuries and MLKIs were included. In the meta-analysis, data based on the number of meniscus and cartilage injuries were extracted and pooled. Lysholm and Tegner scores were analyzed using two-sample Z-tests to calculate the non-weighted mean difference (NMD). A meta-regression analysis was also performed to determine the effect of single ACL injury and MLKI/study design. Results Sixteen studies on single ACL injury and 14 studies on MLKI were included in this analysis. In the analysis, there were significant decreases in Lysholm score (NMD − 5.3 [95% confidence interval (CI) − 7.37 to − 3.23]) and Tegner score (NMD − 0.25 [95% CI − 0.45 to − 0.05]) and increases in risk of meniscus tear (odds ratio [OR] 1.73 [95% CI 1.1–2.73], p = 0.01) and cartilage injury (OR 2.48 [95% CI 1.46–4.2], p = 0.0007) in the delayed surgery group regardless of single ACL injury or MLKI. The result of the meta-regression analysis indicated that single ACL injury and MLKI/study design were not significant moderators of overall heterogeneity (p > 0.05). Conclusions Our study suggests that delayed ACL surgery significantly resulted in a higher risk of meniscus tear and cartilage injury and decreased Lysholm and Tegner scores compared to early ACL surgery. The Lysholm scores in the delayed MLKI surgery group were significantly decreased, but the risks of meniscus tear and cartilage injury in the delayed MLKI surgery group remained unclear. Level of evidence Level III, meta-analysis.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries

Kim

Han

Park

et al. 2021

Knee Surg & Relat Res

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“…Thus delayed reconstruction is an attractive option in LRS as structures may heal independently and negate unnecessary interventions, and where proper rehabilitation is not readily available. Though controversial, overall recent trends in literature seem to favour early surgery with improved or similar outcomes compared to delayed surgery [2,42,44,48,[58][59][60].…”

Section: Timingmentioning

confidence: 99%

Current concepts in the assessment and management of multiligament injuries of the knee

Scheepers

Khanduja

Held

2021

SICOT-J

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Multiligament knee injuries (MLKIs), though rare, pose significant challenges to the patient and surgeon. They often occur in the setting of high-velocity trauma and are frequently associated with concomitant intra- and extra-articular injuries, the most immediately devastating of which is vascular compromise. A detailed evaluation is required when acute or chronic MLKIs are suspected, and stress radiography, MRI and angiography are valuable adjuncts to a thorough clinical examination. Surgical treatment is widely regarded as superior to non-surgical management and has been demonstrated to improve functional outcome scores, return to work, and return to sport rates, though the incidence of post-traumatic osteoarthritis remains high in affected knees. However, acceptable results have been obtained with conservative management in populations where surgical intervention is not feasible. Early arthroscopic single-stage reconstruction is currently the mainstay of treatment for these injuries, but some recent comparative studies have found no significant differences in outcomes. Recent trends in the literature on MLKIs seem to favour early surgery over delayed surgery, though both methods have distinct advantages and disadvantages. Due to the heterogeneity of the injury and the diversity of patient factors, treatment needs to be individualised, and a single best approach with regards to the timing of surgery, repair versus reconstruction, surgical technique and surgical principles cannot be advocated. There is much controversy in the literature surrounding these topics. Early post-operative rehabilitation remains one of the most important positive prognostic factors in surgical management and requires a dedicated team-based approach. Though outcomes of MLKIs are generally favourable, complications are abundant and precautionary measures should be implemented where possible. Low resource settings are faced with unique challenges, necessitating adaptability and pragmatism in tailoring a management strategy capable of achieving comparable outcomes.

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“…Multiple knee ligament injuries are not common in the clinic and mainly involve two or more groups of knee ligament structural injuries that can be combined with periarticular structural injuries or accompanied by varying degrees of nerve and vascular injuries or periarticular fractures [1][2][3]. Isolated injury of the extensor apparatus is mostly caused by trauma, and the main manifestations include quadriceps tendon injury, patellar fracture, patellar ligament injury, and avulsion fracture of the tibial tubercle [4,5].…”

Section: Introductionmentioning

confidence: 99%

The outcomes of one-stage treatment for multiple knee ligament injuries combined with extensor apparatus rupture

Zhao

Yang²,

Wu³

et al. 2020

BMC Musculoskelet Disord

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Background: Multiple knee ligament injuries combined with extensor apparatus rupture are serious and complex knee injuries that are rare in clinical practice. The management is extremely challenging and controversial. The aim of this study is to describe a patient collective with multiple knee ligament injuries combined with extensor apparatus injuries in detail and to report the mid-term outcomes of a one-stage surgical treatment regarding subjective outcome scores, complications, knee instability, and ROM. Methods: Eleven of 425 patients with multiple knee ligament injuries combined with extensor apparatus injuries admitted to our hospital were reviewed from July 2008 to May 2017. All patients underwent one-stage repair and reconstruction of multiple knee ligaments and extensor apparatus. The Lysholm knee score and the International Knee Documentation Committee (IKDC) score were adopted to evaluate the surgical effect preoperatively and at a minimum of 2 years' follow-up. Clinical data, including range of motion and knee stability, were also recorded at the final follow-up. Results: Ten patients were followed up with a mean time of 40 (range, 24-60) months. At the last follow-up, 8 patients had joint flexion range of motion greater than or equal to120 degrees, 2 patients had joint flexion range of motion of 100-120 degrees, and 1 patient had active knee extension limitation of 5 degrees. Stress radiographs showed that the mean differences in posterior displacement were reduced from 10.8 ± 3.0 mm preoperatively to 2.0 ± 2.5 mm at the last follow-up. There were significant improvements in stress radiographs from pre-to postoperative states for all patients with multiple knee ligament injuries. The Lysholm score ranged from 85 to 96, with a mean of 92.1 (compared with 33 before surgery, P < 0.05). The final IKDC scores were A in 2 patients (20%), B in 7 (70%), and C in 1 (10%). Nine of the 10 patients (90%) returned to their former activity level. Conclusion: Multiple knee ligament injuries combined with extensor apparatus rupture are rare. Single-stage management of the repair and reconstruction of multiple knee ligaments and extensor apparatus with proper rehabilitation is an effective and reliable procedure to restore knee stability and function. Level of evidence: Level IV, therapeutic case series.

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Major concern in the multiligament-injured knee treatment: A systematic review

Cited by 42 publications

References 35 publications

A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries

A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries

Current concepts in the assessment and management of multiligament injuries of the knee

The outcomes of one-stage treatment for multiple knee ligament injuries combined with extensor apparatus rupture

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