Multiligamentous Knee Injuries: Current Concepts Review

Abstract

Multiligamentous knee injuries (MLKI) are rare but devastating injuries that have a potential to cause long-term sequelae and significant morbidity. Frequently occurring concomitantly with knee dislocations (KD), MLKI have many risk factors that influence their incidence and treatment outcomes. Proper understanding of these risk factors can assist the surgeon with evaluation, surgical planning, and managing patient expectations both pre- and postoperatively. The purpose of this review is fourfold: (1) identify the risk factors and injuries associated with MLKI, (2) describe factors implicated in the treatment of MLKI, (3) report the effect of these risk factors on outcomes of MLKI, and (4) provide a brief insight into MLKI at our tertiary referral academic care center. This was a retrospective review of literature relevant to MLKI. Studies that described injuries, risk factors, treatment techniques, or outcomes associated with MLKI were included in our review. A total of 35 studies (consisting of level 3 and 4 evidence) published between 2009 and 2020 were found and included in our analysis. In addition, 25 patients who underwent treatment for MLKI at the University of Chicago Medical Center between December 2015 and December 2019 were included in our analysis. MLKI tend to occur in the younger male population. Increasing age, body mass index, and severity of the injury have been correlated with worse functional and patient-reported outcomes. Operative treatment is indicated for MLKI; however, timing and repair versus reconstruction is still debated, and is often decided on a patient by patient basis. Retrospective cohort studies have indicated that reconstruction may be favored; however, further more rigorous studies are needed to better characterize this finding. MLKIs are devastating injuries with significant variability in presentation, treatment, and outcome. Variations in these are largely attributable to the mechanism and severity of injury, timing, and surgeon preference. A holistic approach, and understanding of the present literature, is required to best optimize patient outcome.

No effect of dislocation status at arrival in emergency department on outcome of knee joint dislocations

“…While conservative treatment showed inferior results, primary stabilisation of highly unstable knee joints with an external fixator or primary ligament bracing showed significantly better results [9,12,15,24]. A meta-analysis published by Frosch et al comparing ligament bracing and reconstruction of the ACL and/or PCL showed comparable results, including dislocation of Schenck II and higher dislocations [4].…”

“…The incidence of knee dislocation is relatively low, estimated to range between 0.02 and 0.2 per 100,000 people per year [12,25,32]. However, the incidence is higher in certain subgroups, such as athletes and young men, who have an increased risk of sustaining traumatic injuries [32].…”

“…In a systematic review, Medina et al reported up to 18% of vascular injuries and up to 25% of nerve injuries [19]. Treatment guidelines for knee dislocation typically include reduction of the knee joint, stabilisation with external or internal fixation, reconstruction of injured neurovascular and ligamentous structures and rehabilitation procedures to restore joint function [12,15,24,28,37].…”

Do Age and Timing Influence the Outcomes of Single‐stage Reconstruction of Multiple Ligament Knee Injuries? 5‐10 Years Follow Up

“…It has been widely accepted that surgical treatment of MLKIs could obtain better functional outcomes compared to old conservative treatments, 22 , 23 , 24 and the surgery tended to be performed several days post‐injury to allow the alleviation of the swelling and acute inflammation. 25 , 26 , 27 The available literature demonstrates promising outcomes associated with single‐stage reconstruction of MLKIs.…”

Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

“…ultiligament knee injury (MLKI) encompasses a heterogeneous grouping of injuries involving the cruciate and/or collateral ligaments. The injury can be accompanied by a true dislocation of the tibiofemoral joint with various degrees of injury to the surrounding neurovascular structures, soft tissue, and osseous architecture of the knee [1][2][3] . Isolated injury to the extensor mechanism (EM), involving quadriceps tendon injury, patellar fracture, patellar tendon injury, or avulsion of the tibial tubercle, often occurs in the setting of high-energy trauma [4][5][6] .…”