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

Abstract

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.

Diagnosis and treatment strategies of the multiligament injured knee: a scoping review

“…Several recent systematic reviews assessing MLKI define the term specifically as ‘disruption of at least two of the four major knee ligaments, comprising the ACL, PCL, MCL (and PMC) and LCL (and PLC)’ 1 4 15 23. Numerous original research studies and systematic reviews do not explicitly define their interpretation of MLKI, or do not define their interpretation of the ‘four primary knee ligaments’ 24–30. One recent systematic review defined MLKI as ‘three or more ligaments injured and/or knee dislocation’ 31.…”

Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients

“…As MRI accuracy could vary between acute and chronic injuries, 10,13 this could have been a confounding factor. The time from MRI to surgery also varied between patients: as longer delays from MRI to surgery could lead to the appearance of new lesions associated with instability, 3,10,14 especially meniscal and chondral lesions, this could have acted as a confounding factor. However, the time from MRI to surgery was not associated with the diagnostic accuracy of MRI and thus potentially did not confound our results.…”

“…Multiple ligament knee injuries (MLKIs) are a rare entity, with an incidence of 0.02% to 0.2% of all orthopaedic injuries 18 but with a high rate of associated vascular (5%-18.4%) and nerve (19.2%-25%) injuries. 14,17,18,21 A better understanding of the diagnostic accuracy of magnetic resonance imaging (MRI) to identify MLKIs will improve surgical planning, avoiding a misdiagnosis and inadequate treatment, 2 of the main causes of failure when treating MLKIs. 15,29 Because a clinical diagnosis based on an examination is usually difficult to make because of pain and swelling, 3,10,16 stress radiography 1,9,13 and MRI are essential to establish an accurate diagnosis.…”

Synovial Fluid Inflammatory Profiles did not Differ between Isolated Anterior Cruciate Ligament and Multi-ligament Knee Injuries

“…[1,16,18,19,25,27] The prevalence of postoperative arthro brosis is greater following surgical treatment of multi-ligament knee injury (MLKI) than with isolated anterior cruciate ligament (ACL) injuries. [12,13,17] It has been proposed that the increased prevalence of postoperative arthro brosis after MLKIs compared to isolated ACL injuries may be due to increased in ammation secondary to greater trauma to the joint. [9,20] The purpose of this study was to compare synovial concentrations of pro-and anti-in ammatory cytokines between patients that have a MLKI or isolated ACL injury.…”