Cartilage and Meniscus Injuries Are More Common in Patients Undergoing Delayed Multiligament Reconstruction

Shamrock, Alan G.; Hall, James R L; Hajewski, Christina; An, Qiang; Duchman, Kyle R.

doi:10.1055/s-0040-1716378

Cited by 6 publications

(7 citation statements)

References 44 publications

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“…Vascular injury occurred in 3.5% of the cases, similar to the proportions reported in 2 recent single-center studies (2.7% 18 and 4.3% 24 ) but lower than the proportion reported in the meta-analysis by Kim et al (18.4%) 19 . Nearly 78% of cases with vascular injuries were MLKIs with PCL and lateral-side involvement.…”

Section: Discussionsupporting

confidence: 83%

Presentation and Surgical Management of Multiple Ligament Knee Injuries

Poploski

Lynch

Burns

et al. 2023

Journal of Bone and Joint Surgery

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Background:Multiple ligament knee injuries (MLKIs) represent a spectrum of injury patterns that are often associated with concomitant musculoskeletal and neurovascular injuries, complex treatment, and postoperative complications. However, there has not been high-level evidence describing the presentation and treatment of MLKIs. The purpose of this multicenter retrospective study was to describe characteristics of MLKIs, their management, and related complications using a pathoanatomic MLKI classification system based on the Schenck Knee Dislocation classification system.Methods:This review identified and analyzed MLKIs that occurred between 2011 and 2015. Cases with an MLKI were included in this study if there was a complete tear of ≥2 ligaments and at least 1 ligament was repaired or reconstructed. Cases in which a ligament was deemed clinically incompetent due to a partial ligament tear and required surgical repair or reconstruction were considered equivalent to grade-III tears for inclusion and classification. Demographic information, the mechanism of injury, times from injury to presentation to an orthopaedic surgeon and to surgery, the ligament injury pattern, associated injuries, surgical procedures, and complications were captured. Data were analyzed descriptively.Results:A total of 773 individuals from 14 centers who underwent surgery for an MLKI were reviewed. The mean age of the individuals was 30.5 ± 12.7 years, and 74.2% were male. The most common mechanism involved sports (43.2%). The median time from injury to presentation to the orthopaedic surgeon was 11 days (interquartile range [IQR], 3 to 48 days), and the time to initial ligament surgery was 64 days (IQR, 23 to 190 days). While the most common injury patterns were an anterior cruciate ligament tear combined with either a medial-sided (MLK 1-AM, 20.7%) or lateral-sided (MLK 1-AL, 23.2%) injury, one-third (34.7%) were bicruciate injuries. Associated injuries most often involved menisci (55.6%), nerves (18.5%) and tendons (15.6%). The method of surgical intervention (repair versus reconstruction), external fixator use, and staging of procedures varied by MLKI classification. Loss of motion (11.4%) was the most common postoperative complication.Conclusions:A better understanding of the clinical characteristics and management of the various MLKI patterns can be used to support clinical decision-making and individualized treatment of these complex injuries, and may ultimately lead to enhanced outcomes and reduced associated risks.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 83%

Presentation and Surgical Management of Multiple Ligament Knee Injuries

Poploski

Lynch

Burns

et al. 2023

Journal of Bone and Joint Surgery

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“…yy This included 10 studies for the 3-week analysis zz and 4 for the 6-week analysis. 3,32,44,51 Overall, 1172 patients were included: 690 in the early treatment group and 482 in the delayed. For the 3-week cutoff, 394 patients underwent early treatment at a mean 7.0 6 5.0 days after surgery, and 317 were treated late at a mean 275.4 6 498.4 days; however, this was not specified for all studies in the 6-week cutoff.…”

Section: Results: Part 2-mlik Surgery Study Selection and Characteris...mentioning

confidence: 99%

“…M-H, Mantel-Haenszel. yy References 3,20,21,32,35,40,44,45,50,51,53,57,59,60. zz delayed surgery without increasing the risk for postoperative stiffness and ROM deficits. Furthermore, similar or even higher functional outcome scores were found in patients treated early versus late.…”

Section: Discussionmentioning

confidence: 99%

Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

et al. 2022

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Background: Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. Purpose: To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. Study Design: Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4. Methods: A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs. Results: For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P > .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses. Conclusion: This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.

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“…Early ligamentous repair (i.e., intervention within the first 6 weeks of injury) helps restore tibiofemoral stability and reduce the risk of secondary injuries, such as further meniscal and chondral lesions 59 . Approximately 42.8% to 48.0% of patients with delayed treatment of their multiligamentous knee injury have had secondary injuries from chondral lesions 60,61 . The effects of high rates of secondary injuries after knee dislocations are further pronounced in the high rates of patients (42%) who develop osteoarthritis after knee dislocations 62 .…”

Section: Sports Medicinementioning

confidence: 99%

Team Approach: Treatment of Traumatic Dislocations of the Knee

et al. 2023

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Traumatic knee dislocations are complex injuries that can be associated with compromise of the neurovascular structures about the knee.Various classification systems for knee dislocations exist in the literature but should be used with caution as a prognostic tool because many knee dislocations fit into more than 1 category.Special populations of knee dislocations, such as obese patients and high-velocity mechanism injuries, require additional caution during the initial evaluation for possible vascular injuries.

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Cartilage and Meniscus Injuries Are More Common in Patients Undergoing Delayed Multiligament Reconstruction

Cited by 6 publications

References 44 publications

Presentation and Surgical Management of Multiple Ligament Knee Injuries

Presentation and Surgical Management of Multiple Ligament Knee Injuries

Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

Team Approach: Treatment of Traumatic Dislocations of the Knee

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