Diagnostic and Management Strategies for Multiligament Knee Injuries

Burrus, M. Tyrrell; Werner, Brian C.; Griffin, Justin W.; Gwathmey, F. Winston; Miller, Mark D.

doi:10.2106/jbjs.rvw.o.00020

Cited by 41 publications

(62 citation statements)

References 71 publications

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“…Early surgery (<3 week) has shown higher incidences of postoperative stiffness and a fixed flexion deformity with higher rates of manipulation under general anesthesia as compared to delayed repair. 5 20 21 22 …”

Section: Resultsmentioning

confidence: 99%

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Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Goyal

Tanwar

Joshi

et al. 2017

IJOO

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Background:Multiligamentous injuries of knee remain a gray area as far as guidelines for management are concerned due to absence of large-scale, prospective controlled trials. This article reviews the recent evidence-based literature and trends in treatment of multiligamentous injuries and establishes the needful protocol, keeping in view the current concepts.Materials and Methods:Two reviewers individually assessed the available data indexed on PubMed and Medline and compiled data on incidence, surgical versus nonsurgical treatment, timing of surgery, and repair versus reconstruction of multiligamentous injury.Results:Evolving trends do not clearly describe treatment, but most studies have shown increasing inclination toward an early, staged/single surgical procedure for multiligamentous injuries involving cruciate and collateral ligaments. Medial complex injuries have shown better results with conservative treatment with surgical reconstruction of concomitant injuries.Conclusion:Multiligamentous injury still remains a gray area due to unavailability of a formal guideline to treatment in the absence of large-scale, blinded prospective controlled trials. Any in multiligamentous injuries any intervention needs to be individualized by the presence of any life- or limb-threatening complication. The risks and guarded prognosis with both surgical and non-surgical modalities of treatment should be explained to patient and relations.

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Section: Resultsmentioning

confidence: 99%

“…Type of treatment (surgical/nonsurgical), timing of surgery (<3 weeks/>3 weeks), and results of repair versus reconstruction were recorded from the studies. We made use of Schenck Classification of Knee Dislocations for standardization of ligament injuries 5 [ Table 1 ].…”

Section: Methodsmentioning

confidence: 99%

Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Goyal

Tanwar

Joshi

et al. 2017

IJOO

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“…Outcomes for ligamentous repair in MLKIs are commonly reported to be inferior to reconstruction. [24,25] Yet, bony avulsions form an exception for which repair is favored [26] and some suggest to repair ligaments acutely when they are torn at their insertions. [27] Furthermore, collateral ligaments have an acceptable healing capacity although with distinct differences for the medial and lateral side.…”

Section: Techniques Repairmentioning

confidence: 99%

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Held

North

Bormann

et al. 2020

JASSM

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Recent advances in the management of multiligament knee injuries have led to improvements in diagnosis and management and allowed enhanced understanding of the biomechanics of ligament reconstructions. Most studies arise from subspecialist knee centers in high-income countries and can inform global strategies, but each patient encounter and environment is unique and not all recommendations may be feasible in every setting. For ligamentous injuries, the gold standard is acute arthroscopic, single-stage ligament reconstruction, although this is not always possible in the limited resource setting (LRS). For these circumstances, non-operative management, although rarely promoted, may be preferred in selected patients. Furthermore, acute surgery relies on adequate post-operative physiotherapy, otherwise a delayed surgical approach should be considered. Reconstruction remains the gold standard, but acute repair is an option for medial collateral and posterior cruciate ligaments and for avulsion fractures. For a vascular examination, a careful clinical assessment and routine angiography should be done in LRS. Due to the heterogeneity of injury and patient profile, outcomes vary widely and need to be interpreted in the context of the surgical setup. The main complications of these injuries are stiffness, residual laxity, and surgical site infections. Future trends will need to include a global perspective and provide solutions for surgeons in various parts of the world.

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“…Aufgrund der großen Krafteinwirkung, die nötig ist, um eine Kniegelenksluxation zu verursachen, sowie der anatomisch engen Lagebeziehung von Gefäßen und Nerven, sind neurovaskuläre Begleitverletzungen häufig und haben maßgebli-chen Einfluss auf die Prognose [3].…”

Section: Begleitverletzungunclassified