Poorer functional Outcomes in Patients with Multi-Ligamentous Knee Injury with Concomitant Patellar Tendon Ruptures at 5 years Follow-Up

Mojica, Edward S.; Bi, Andrew S; Vasavada, Kinjal; Moran, Jay; Buzin, Scott; Kahan, Joseph B; Alaia, Erin F.; Jazrawi, Laith M.; Medvecky, Michael J.; Alaia, Michael J.

doi:10.1007/s00167-022-07110-3

Cited by 5 publications

(7 citation statements)

References 32 publications

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“…Similarly, a recent Delphi panel suggested the inclusion of an additional “-O” modifier to indicate open injuries 26 . Adding EM injuries as a “sixth stratified level” has been previously suggested by Mojica et al 7 . The widely used Schenck KD Classification captures a heterogeneous group of injuries, and adding such a modifier can improve our ability to communicate and guide treatment for concurrent EM injury.…”

Section: Discussionmentioning

confidence: 99%

“…Early postoperative joint mobilization is important to reduce the development of arthrofibrosis and knee stiffness, but it must be balanced against protection of the EM repair 9 . Mojica et al reported that patients in their cohort were treated with a hinged knee brace locked in extension for a minimum of 3 weeks; however, the period of immobilization was dependent on the surgeon and was often based on the number of ligaments reconstructed 7 . Additionally, 75% of the patients in that study underwent staged treatment of the concomitant EM injury and MLKI 7 .…”

Section: Discussionmentioning

confidence: 99%

“…In rare cases, MLKIs may present with concomitant injury to the EM. One study found that 12 (5%) of a cohort of 237 patients with MLKI presented with concomitant EM injury 7 .…”

mentioning

confidence: 99%

“…However, both studies were limited by small patient cohorts with various knee injuries and lacked clinical comparison with a control group. Mojica et al compared outcomes in patients with MLKI who did and did not have a concomitant patellar tendon rupture and found worse functional outcomes in the patients who had patellar tendon rupture 7 . While that study included a control group, it was still limited by a small sample size of 12 patients per group, thereby making it difficult to draw conclusions regarding treatment strategies.…”

mentioning

confidence: 99%

“…Given the rarity of these injuries, there is a paucity of literature to guide optimal treatment strategies for MLKI with concomitant EM injury [7][8][9][10][11] . One study reported on a series of 15 patients, most of whom achieved favorable outcomes after undergoing staged EM repair followed by ligament reconstruction 10 , whereas another study reported a 90% rate of return to the prior activity level after single-stage MLKI treatment combined with EM repair 11 .…”

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confidence: 99%

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Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

Medvecky

Kahan

Richter

et al. 2023

Journal of Bone and Joint Surgery

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Background: Multiligament knee injury (MLKI) with associated extensor mechanism (EM) involvement is a rare injury, with limited evidence to guide optimal treatment. The purpose of this study was to identify areas of consensus among a group of international experts regarding the treatment of patients with MLKI and concomitant EM injury.Methods: Utilizing a classic Delphi technique, an international group of 46 surgeons from 6 continents with expertise in MLKI undertook 3 rounds of online surveys. Participants were presented with clinical scenarios involving EM disruption in association with MLKI, classified using the Schenck Knee-Dislocation (KD) Classification. Positive consensus was defined as ‡70% agreement with responses of either "strongly agree" or "agree," and negative consensus was defined as ‡70% agreement with "strongly disagree" or "disagree."Results: There was a 100% response rate for rounds 1 and 2 and a 96% response rate for round 3. There was strong positive consensus (87%) that an EM injury in combination with MLKI significantly alters the treatment algorithm. For an EM injury in conjunction with a KD2, KD3M, or KD3L injury, there was positive consensus to repair the EM injury only and negative consensus regarding performing concurrent ligamentous reconstruction at the time of initial surgery. Conclusions:In the setting of bicruciate MLKI, there was overall agreement on the significant impact of EM injury on the treatment algorithm. We therefore recommend that the Schenck KD Classification be updated with the addition of the modifier suffix "-EM" to highlight this impact. Treatment of the EM injury was judged to have the highest priority, and there was consensus to treat the EM injury only. However, given the lack of clinical outcome data, treatment decisions need to be made on a case-by-case basis with consideration of the numerous clinical factors that are encountered.Clinical Relevance: Little clinical evidence exists to guide the surgeon on the management of EM injury in the setting of a multiligament injured or dislocated knee. This survey highlights the impact that EM injury has on the treatment algorithm and provides some guidance for management until a further large case series or prospective studies are undertaken. *A list of the Knee Fracture-Dislocation Study Group members is included in a note at the end of the article.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In rare cases, MLKIs may present with concomitant injury to the EM. One study found that 12 (5%) of a cohort of 237 patients with MLKI presented with concomitant EM injury 7 .…”

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

Medvecky

Kahan

Richter

et al. 2023

Journal of Bone and Joint Surgery

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Outcomes after multiligament knee injury worsen over time: A systematic review and meta‐analysis

Klasan,

Maerz,

Putnis

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeMultiligament knee injuries (MLKIs) are devastating injuries that can have life‐long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow‐up.MethodsFour databases were queried for surgical outcome‐based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2‐year follow‐up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow‐up period, anatomical region and posterior‐cruciate ligament (PCL)‐based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random‐effects model analysis was performed.ResultsAfter the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow‐up was 4.06 years (range 2–12.7). The mean Lysholm score at 2‐year follow‐up was 86.09 [95% confidence interval [CI]: 82.90–89.28], with a yearly decrease of −0.80 [95% CI: −1.47 −0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56–86.14], with a yearly decrease of −1.99 [95% CI: −3.14 −0.84] (p < 0.001). Non‐PCL‐based injuries had a higher IKDC 83.69 [75.55–91.82] vs. 75.00 [70.75–79.26] (p = 0.03) and Lysholm score 90.84 [87.10–94.58] versus 84.35 [82.18–86.52] (p < 0.01) than PCL‐based injuries, respectively.ConclusionAccording to the present systematic review and meta‐analysis of MLKIs with minimum 2‐year follow‐ups, the patients who suffered an MLKI can expect to retain around 80‐85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL‐based injuries at 2 years postoperative.Level of EvidenceLevel IV meta‐analysis.

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Good long‐term patients reported outcomes, return‐to‐work and return‐to‐sport rate and survivorship after posterior cruciate ligament (PCL)‐based multiligament knee injuries (MLKI) with posteromedial corner tears as significant risk factor for failure

Pizza,

Di Paolo,

Grassi

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To assess the survival rate and associated risk factors of a wide cohort of patient’s underwent surgical treatment for posterior cruciate ligament (PCL)-based multiligament knee injury (MLKI) at long-term follow-up and to investigate the long-term patient’s reported outcomes (PROMS) and functional activity. Methods All cases of PCL-based MLKI performed at one single sport-medicine institution were extracted and patient’s with a minimum 2 years of follow-up included. VAS, Lysholm, KOOS, Tegner Activity level scores, the incidence and time of return to sport (RTS) and return to work (RTW) were collected before, after surgery and at final follow-up. A multivariate logistic regression was performed to investigate the outcomes associated with the patient’s acceptable symptoms state (PASS) for each sub-score of the KOOS. The Kaplan–Meier method with surgical failure (re-operation to one of the reconstructed ligaments) as endpoint was used to perform the survivorship analysis for the entire cohort. Results Forty-two patients were included and evaluated at an average of 10 years. All PROMS significantly improved from pre- to post-surgery (range ηp2 0.21–0.43, p < 0.05) except for the Tegner score which significantly improved from pre-surgery and to final follow-up (ηp2 = 0.67, p < 0.001). RTW was achieved in the 95.2% after 2.4 ± 1.9 months. RTS was achieved in 78.6% after 6.7 ± 5.0 months. The higher number of surgeries were the significant negative predictors of PASS for the KOOS sub-scales Sport (p = 0.040) and Quality of Life (p = 0.046), while the presence of meniscal lesions was a significant negative predictor of PASS only for the KOOS sub-scale of Sport (p = 0.003). Six patients (14.3%) underwent reoperation and were considered as surgical failures. The global survivorship was 95.2%, 92.6%, 87.1%, and 74.7% at 2, 5, 12, and 15 years, respectively. The survivorship in patient undergoing PMC reconstruction surgery was significantly lower (p = 0.004; HR 7.1) compared to patients without a PMC lesion. Conclusion Good-to-excellent PROMS could be obtained and maintained at long-term follow-up after surgery, with the higher number of surgeries and meniscal lesions as significant negative predictors of the PASS. Moreover, the presence of a PMC lesion significantly increases the risk of the PCL reconstruction failure. Level of evidence III.

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Poorer functional Outcomes in Patients with Multi-Ligamentous Knee Injury with Concomitant Patellar Tendon Ruptures at 5 years Follow-Up

Cited by 5 publications

References 32 publications

Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

Outcomes after multiligament knee injury worsen over time: A systematic review and meta‐analysis

Good long‐term patients reported outcomes, return‐to‐work and return‐to‐sport rate and survivorship after posterior cruciate ligament (PCL)‐based multiligament knee injuries (MLKI) with posteromedial corner tears as significant risk factor for failure

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