Comparison of KD3-M and KD3-L Multiligamentous Knee Injuries and Analysis of Predictive Factors That Influence the Outcomes of Single-Stage Reconstruction in KD3 Injuries

Sundararajan, Silvampatti Ramasamy; Sambandam, Balaji; Ramakanth, Rajagopalakrishnan; Rajasekaran, Shanmuganathan

doi:10.1177/2325967118794367

Cited by 14 publications

(35 citation statements)

References 49 publications

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“…10 In other populations, injury to three ligaments has been identified as the most common injury pattern with KDIII-M and KDIII-L constituting 52.4 and 28.1% of injuries, respectively. 2,4 This finding supports previous literature that indicated MLKI were more commonly associated with medial-sided ligament injuries. 20 KDI injuries were the most frequent injury in our cohort (52%), followed by KDIII (44%) (►Table 1).…”

Section: Injury Patternsupporting

confidence: 90%

“…4 The Schenck classification defines the severity of injury based on the injured ligaments involved (►Table 2), while the Kennedy classification is based on the direction of displacement of the tibia. 2,4,11…”

Section: Classificationmentioning

confidence: 99%

“…Generally, single-stage management is viewed as superior as two-stage management results in increased arthrofibrosis, longer recovery times, longer periods of time off of work, higher failure rates, and increased patient morbidity due to the need to undergo a second surgery. 2,29,32 When possible, Fanelli et al reported successful outcomes for combined PCL, ACL, medial, and lateral reconstruction in both acute and chronic MLKI with global laxity. 29 They described no difference in outcomes in single-stage reconstruction of either lateral or medial sided injuries and described preference for single-stage versus two-stage management.…”

Section: Single Versus Two-stage Managementmentioning

confidence: 99%

“…1 KD comprise less than <0.2% of orthopaedic injuries with a reported incidence of 0.02%. [2][3][4][5][6][7] However, the incidence may be underestimated due to an unknown number of spontaneous reductions, with reports of spontaneous reduction in up to 50% of KD. 4,[7][8][9] Therefore, the modern definition of KD include all ligament injuries that involve two or more of the major knee ligamentous structures (anterior cruciate ligament [ACL], posterior cruciate ligament [PCL], lateral collateral ligament [LCL], and medial collateral ligament [MCL]).…”

Section: Introductionmentioning

confidence: 99%

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Multiligamentous Knee Injuries: Current Concepts Review

et al. 2021

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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.

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Section: Injury Patternsupporting

confidence: 90%

Section: Classificationmentioning

confidence: 99%

Section: Single Versus Two-stage Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multiligamentous Knee Injuries: Current Concepts Review

et al. 2021

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“…** Of these studies, 8 out of 9 reported a prevalence that was in the range of 28.2% to 66.7%. 4,8,12,17,22,32,33,35 One study reported meniscal tears in 15 of 17 patients (88%). 15 Thirteen studies reported having performed a reconstruction of all torn ligaments, yy while 1 study reported on ligament repairs of all injured ligaments 15 and another reported on repair versus reconstruction of the fibular collateral ligament and posterolateral corner.…”

Section: Resultsmentioning

confidence: 99%

Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

et al. 2020

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Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

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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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Comparison of KD3-M and KD3-L Multiligamentous Knee Injuries and Analysis of Predictive Factors That Influence the Outcomes of Single-Stage Reconstruction in KD3 Injuries

Cited by 14 publications

References 49 publications

Multiligamentous Knee Injuries: Current Concepts Review

Multiligamentous Knee Injuries: Current Concepts Review

Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

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

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