Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries

Alentorn-Geli, Eduard; Lazarides, Alexander L.; Utturkar, Gangadhar M.; Myers, Heather; Samuelsson, Kristian; Choi, J. H. James; Stuart, Joseph J.; Moorman, Claude T.

doi:10.1007/s00167-018-5053-9

Cited by 16 publications

(26 citation statements)

References 50 publications

(72 reference statements)

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“…The pooled results for concomitant lateral meniscal tears showed that 27.5% of MLKIs involved lateral meniscal tears. In contrast, the incidence of lateral meniscal tears in MLKIs varied across studies, ranging from 1.8% to 56.4% 3,77 ; however, the overall pooled rate of lateral meniscal tears in the MLKI group was 26.5%, similar to that reported by Magnussen et al 53 However, Wyatt et al 82 indicated a higher incidence of lateral meniscal tears in the MLKI group (37.9%) than in this study. The incidence rate of lateral meniscal tears in isolated ACL injuries ranged from 48.7% (73/150) 23 to 13.2% (31/235) in previous studies.…”

Section: Discussionsupporting

confidence: 64%

“…In brief, the incidence rates of cartilage injuries concomitant with MLKIs or isolated ACL injuries also varied across studies, ranging from 11.2% to 76.6% for isolated ACLs injuries 23,72 and from 5% to 43.6% for MLKIs. 3,37 The pooled incidence of cartilage injuries in the MLKI group in this study was lower than that in the isolated ACL injury group in other large cohort series. 50,56,82 In this study, high incidence rates of medial and lateral meniscal tears were found in the MLKI group; the incidence rates were similar to or lower than those in the isolated ACL injury groups in previous studies 50,56,82 (Appendix Table A1).…”

Section: Discussioncontrasting

confidence: 50%

Section: Discussioncontrasting

confidence: 50%

“…7,40,47 There are many other complications in MLKIs, and a careful evaluation is therefore essential. Alentorn-Geli et al 3 There are several limitations to the present study. First, the lack of randomization, low methodological quality, and heterogeneity of the studies may have reduced the external validity of the studies and this meta-analysis.…”

Section: Discussionmentioning

confidence: 79%

“…There are many other complications in MLKIs, and a careful evaluation is therefore essential. Alentorn-Geli et al 3 observed osteoarthritis development (33% [13/39]) after a mean 27 months of follow-up in MLKI injuries. Roman et al 65 and Richter et al 63 examined tibial nerve injury (9.2% [11/119]), and Richter et al and Engebretsen et al 16 investigated combined patellar tendon injuries (7.5% [11/147]) and patellar dislocations (5.9% [5/85]) with MLKI, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Associated Lesions of Multiligament Knee Injuries: A Systematic Review and Meta-analysis

Kim

Park

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The incidence of concomitant injuries, including meniscal and cartilage injuries, has not been adequately reported in previous studies on multiligament knee injury (MLKI) because their primary focal points have been the degree of ligament injury, treatment strategy, involvement of other soft tissues, and neurovascular injury. Purpose: To analyze the incidence of associated lesions in MLKIs, including medial and lateral meniscal injuries, cartilage lesions, and complications. Study Design: Systemic review; Level of evidence, 4. Methods: The PubMed, Embase, Cochrane Library, CINAHL, and Scopus databases were searched between inception and April 30, 2020. Studies were included if they reported the incidence rates of medial and/or lateral meniscal tears and cartilage injuries in cases of MLKIs. For the meta-analysis, data were extracted on clinical outcomes measured according to the number of medial and/or lateral meniscal tears, cartilage injuries, and complications. Results: A total of 45 studies were included in the MLKI analysis (3391 patients). The pooled rate of medial meniscal tears was 30.4% (95% CI, 24.1%-37.1%; P < .0001; I 2 = 85.8%). The pooled rate of lateral meniscal tears was 27.5% (95% CI, 20.3%-35.3%; P < .0001; I 2 = 89.6%). The pooled rate of cartilage injuries was 27.5% (95% CI, 22.1%-33.3%; P < .0001; I 2 = 86.8%). The pooled rates of peroneal nerve injuries, vascular injuries, and arthrofibrosis were 19.2% (95% CI, 14.2%-24.7%; P < .001; I 2 = 81.3%), 18.4% (95% CI, 13.2%-24.3%; P < .0001; I 2 = 81.0%), and 11.2% (95% CI, 8.1%-14.7%; P = .0018; I 2 = 54.0%), respectively. Conclusion: The pooled rates of meniscal tears and cartilage injuries concomitant with MLKIs were high, ranging from 27% to 30%, and the pooled rates of peroneal nerve injury, vascular injury, and arthrofibrosis were considerable, ranging from 11% to 19%. The influence of these associated lesions on clinical results should be evaluated in future clinical studies.

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Section: Discussionsupporting

confidence: 64%

Section: Discussioncontrasting

confidence: 50%

Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Incidence of Associated Lesions of Multiligament Knee Injuries: A Systematic Review and Meta-analysis

Kim

Park

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Structured Rehabilitation Considerations to Improve Outcomes After Complex Athletic Knee Injury

Nyland,

Pyle,

Carter

2024

Sports Injuries

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Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation

Fayed

Rothrauff

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose In single-stage ACL-PCL reconstruction, there is uncertainty regarding the order of graft tensioning and fixation, as well as the optimal knee flexion angle(s) for graft fixation. A systematic review of clinical studies of single-stage combined ACL-PCL reconstruction was performed to determine whether a particular fixation sequence and/or knee flexion angle is associated with superior outcomes. Methods A systematic review was performed according to PRISMA guidelines. All levels of evidence were included. All outcome measures were extracted, including physical examination values, radiographic measurements, and objective and subjective outcomes. Results Of the 19 included studies, 17 tensioned and fixed the PCL before the ACL. Only four studies reported the methods/ forces used for graft tensioning. Across studies, the ACL was fixed at variable knee flexion angles, from full extension to 70°. Conversely, 3 studies fixed the PCL at a knee flexion angle < 45°, while the remaining 16 studies fixed the PCL at a flexion angle > 70°. Patient-reported outcomes were qualitatively similar between groups. Conclusions This systematic review found considerable variability in graft tension, fixation sequence, and knee flexion angle at the time of fixation, with insufficient evidence to support specific surgical practices. Most commonly, the PCL is fixed before the ACL graft, with fixation occurring at a knee flexion angle between 70° and 90° and near full extension, respectively. The methodology for quantifying the forces applied for graft tensioning is rarely described. Given this clinical equipoise, future studies should consistently report these surgical details. Furthermore, prospective, randomized studies on the treatment of multiligament knee injuries are needed to improve outcomes in patients. Level of evidence IV.

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Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries

Abstract: Cross-sectional comparative study, Level III.

Cited by 16 publications

References 50 publications

Incidence of Associated Lesions of Multiligament Knee Injuries: A Systematic Review and Meta-analysis

Incidence of Associated Lesions of Multiligament Knee Injuries: A Systematic Review and Meta-analysis

Structured Rehabilitation Considerations to Improve Outcomes After Complex Athletic Knee Injury

Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation

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