Multiple Ligament Knee Injuries

Fanelli, Gregory C.; Fanelli, David G.

doi:10.1055/s-0038-1636910

Cited by 11 publications

(12 citation statements)

References 49 publications

(61 reference statements)

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“…Data for the secondary outcomes analyzed in the present study also compare favorably to previous reports. While the incidence of persistent instability after MLKI reconstruction has been previously reported to range from 18 to 100% (mean=42%), 3 9 persistent instability was noted in only 12% of cases in the present study with at least 1 year of follow-up. Three of these (9.5%) had varus and/or rotational instability and patients underwent successful revision of the PLC component of KD IV reconstructions, and two of these revisions included realignment tibial osteotomies.…”

Section: Discussioncontrasting

confidence: 63%

“…Multiligamentous knee injury (MLKI) is relatively uncommon, but can cause significant functional impairment and devastating long-term sequelae, such as persistent pain and instability, inability to return to previous activities, decreased range of motion (ROM), and post-traumatic osteoarthritis (PTOA). 1 2 3 Surgical treatment of MLKI has been reported to yield better functional outcomes in short- to medium-term follow-up in comparison with conservative treatment. Based on patient-reported outcomes in conjunction with assessments of knee stability and ROM, surgical reconstruction for MLKIs has been recommended over repair.…”

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confidence: 99%

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Outcomes after Multiligament Knee Injury Reconstruction using Novel Graft Constructs and Techniques

et al. 2020

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Clinical outcomes after reconstruction for multiligamentous knee injury (MLKI) can be consistently favorable. However, recent implants and technique advances may allow for improvement in outcomes. Our institution has developed novel graft constructs and techniques for reconstructions with preclinical data supporting clinical use. Our study purpose was to assess clinical outcomes after reconstruction for MKLI using our constructs and techniques. Overall success rate, failure/revision rates, return to work (RTW)/return to sports (RTS) rates, and complications were evaluated testing the hypothesis that novel methods would be associated with clinical benefits with respect to applications and outcomes compared with historical results. We reviewed a single-surgeon, longitudinal database of 42 patients who underwent multiligament reconstruction at our institution using these techniques for at least two-ligament injuries. Visual analogue scale (VAS) pain score and PROMIS (patient-reported outcomes measurement information system) were collected preoperatively and postoperatively at a minimum 1-year follow-up. Among these patients, 33 patients (mean age of 28.9 years, mean body mass index (BMI) of 33.2 kg/m2, mean follow-up of 14.2 months) were included for outcomes analyses. With the definition of success as having a VAS score of less than or equal to 2 without revision/salvage surgery due to recurrent/residual instability or arthritis, overall success rate was 88% (29/33). The mean VAS scores improved from 5 ± 2 to 2 ± 2. The mean preoperative PROMIS mental health score was 36.2 ± 7, general health was 33.5 ± 6, pain was 62.7 ± 8, and physical function score was 29.4 ± 3. At the final follow-up, PROMIS MH was 50.2 ± 10, GH was 44.4 ± 9, pain was 54.3 ± 9, and PF was 42.6 ± 8.4. Return to work rate was 94% (31/33), and 52% (17/33) of patients were able to RTS at any level. Our results demonstrated excellent clinical outcomes associated with a primary success rate of 88% and RTW rate of 94%. Intraoperative complications occurred in 9.5% of cases and revision and failure rates were 9% and 3%, respectively. Our initial results suggest that multiligament reconstructions using novel graft constructs and techniques are safe and effective and can be considered an appropriate option for reconstruction of the full clinical spectrum of MLKIs.

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Section: Discussioncontrasting

confidence: 63%

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confidence: 99%

Outcomes after Multiligament Knee Injury Reconstruction using Novel Graft Constructs and Techniques

et al. 2020

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“…Dessa maneira, a luxação do joelho deve ser avaliada em todo paciente que apresenta lesão em dois ou mais ligamentos desta articulação. 2 3 5 6 7 8 9 10…”

Section: Introductionunclassified

“…A gravidade dessas lesões vasculares está enfatizada pelo fato de que, independentemente do tratamento, a incidência de amputações nesses pacientes é de 12% dos casos. 3 6 8 9 12 14…”

Section: Introductionunclassified

Estudo epidemiológico das lesões multiligamentares do joelho

Pinheiro

Pedrinha

Maia

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Descrever e associar as características das lesões multiligamentares de joelho com o perfil do paciente e mecanismo de trauma. Métodos Trata-se de um estudo transversal que avaliou 82 pacientes com lesões multiligamentares do joelho de setembro de 2016 até setembro de 2018. As variáveis coletadas foram idade, gênero, eixo mecânico, lateralidade, arco de movimento, mecanismo do trauma, lesões associadas, ligamentos afetados e afastamento do trabalho. Resultados A amostra incluiu pacientes de 16 a 58 anos, com média de 29,7 anos, e os homens foram os mais afetados, correspondendo a 92,7% dos casos. O mecanismo de trauma mais comum foi acidente motociclístico (45,1%). O ligamento mais lesado foi o ligamento cruzado anterior (80,5%), seguido do ligamento cruzado posterior (77,1%), do canto posterolateral (61,0%) e do ligamento colateral tibial (26,8%). O tipo de luxação mais frequente era o KD IIIL (30,4%). Apenas 1 paciente apresentou lesão vascular, e 13 (15,9%) apresentaram lesões neurológicas. A maioria das vítimas foi afastada do trabalho (52,4%). Conclusão Há grande diferença entre os pacientes que apresentam lesão multiligamentar no Brasil em relação ao encontrado nos estudos internacionais. Desta forma, convém realizar mais estudos específicos sobre o tema com a nossa população, de modo a aperfeiçoar o tratamento destes pacientes.

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“…In fact, ligament injuries around the knee and dislocations of the knee joint have been poorly described in the context of multiple trauma [15]. Previous studies have suggested anatomic risk factors for knee injuries, including femoral shaft fractures [16,17], combined femur and tibia fractures [18], patella fractures [19], and acetabular fractures [20].…”

Section: Introductionmentioning

confidence: 99%

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

Weber

Solomon

Lefering

et al. 2020

JCM

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Introduction: Ligament injuries around the knee joint and knee dislocations are rare but potentially complex injuries associated with high-energy trauma. Concomitant neurovascular injuries further affect their long-term clinical outcomes. In contrast to isolated ligamentous knee injuries, epidemiologic data and knowledge on predicting knee injuries in severely injured patients is still limited. Methods: The TraumaRegister DGU® (TR-DGU) was queried (01/2009–12/2016). Inclusion criteria for selection from the database: maximum abbreviated injury severity ≥ 3 points (MAIS 3+). Participating countries: Germany, Austria, and Switzerland. The two main groups included a “control” and a “knee injury” group. The injury severity score (ISS) and new ISS (NISS) were used for injury severity classification, and the abbreviated injury scale (AIS) was used to classify the severity of the knee injury. Logistic regression analysis was performed to evaluate various risk factors for knee injuries. Results: The study cohort included 139,462 severely injured trauma patients. We identified 4411 individuals (3.2%) with a ligament injury around the knee joint (“knee injury” group) and 1153 patients with a knee dislocation (0.8%). The risk for associated injuries of the peroneal nerve and popliteal artery were significantly increased in dislocated knees when compared to controls (peroneal nerve from 0.4% to 6.7%, popliteal artery from 0.3% to 6.9%, respectively). Among the predictors for knee injuries were specific mechanisms of injury: e.g., pedestrian struck (Odds ratio [OR] 3.2, 95% confidence interval [CI]: 2.69–3.74 p ≤ 0.001), motorcycle (OR 3.0, 95% CI: 2.58–3.48, p ≤ 0.001), and motor vehicle accidents (OR 2.2, 95% CI: 1.86–2.51, p ≤ 0.001) and associated skeletal injuries, e.g., patella (OR 2.3, 95% CI: 1.99–2.62, p ≤ 0.001), tibia (OR 1.9, 95% CI: 1.75–2.05, p ≤ 0.001), and femur (OR 1.8, 95% CI: 1.64–1.89, p ≤ 0.001), but neither male sex nor general injury severity (ISS). Conclusion: Ligament injuries and knee dislocations are associated with high-risk mechanisms and concomitant skeletal injuries of the lower extremity, but are not predicted by general injury severity or sex. Despite comparable ISS, knee injuries prolong the hospital length of stay. Delayed or missed diagnosis of knee injuries can be prevented by comprehensive clinical evaluation after fracture fixation and a high index of suspicion is advised, especially in the presence of the above mentioned risk factors.

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Multiple Ligament Knee Injuries

Cited by 11 publications

References 49 publications

Outcomes after Multiligament Knee Injury Reconstruction using Novel Graft Constructs and Techniques

Outcomes after Multiligament Knee Injury Reconstruction using Novel Graft Constructs and Techniques

Estudo epidemiológico das lesões multiligamentares do joelho

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

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