Inclusion of open injuries in an updated Schenck classification of knee dislocations based on a global Delphi consensus study

Held, Michael; Scheepers, Waldo; Bormann, Richard von; Wascher, Daniel C.; Richter, Dustin L.; Schenck, Robert C.; Harner, Christopher D.; Alizayagam, Hasan; Mourão, Carlos Fernando de Almeida Barros; Mesquita, Diogo; Arojuraye, Soliudeen; Freitas, Ednei; Patel, Rtesh; Deepak, Shantal; Nahas, Fernanda; Fontes, Paulo Cézar Rezende; Miura, Gabriel M.; Preez, G du; Simoes, Guilherme F.; Marinho, Leandro Balby; Luciano, Roberto Cunha; Gowda, Yogesh; Ribeiro, Bernardo; North, David; Calapodopulos, Constantino; Coutinho, Ennio; Fu, Weili; Ferreira, Frederico Castelo; Passos, Clauco; Jonker, Hannes; Hobbs, Hayden; Grant, John A.; Magobotha, Sebastian; Alves, Marcos Antônio; Amorim, Marcelo Dias de; Denaro, Marcelo; Safran, Marc R.; Moraes, Marcelo Lopes de; Pardiwala, Dinshaw; Lazzarini, Rodrigo; Sherman, Seth L.; Shanmugasundaram, Saseendar; Silvampatti, Sundararajan; Lemos, Wagner; Eustáquio, José Martins Juliano; Venter, Peter

doi:10.1016/j.jisako.2022.02.003

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…Specifying the involved ligaments for all classifications may further guide the prognostication and treatment of MLKIs, although more research will be needed to understand the limitations of the system. Information on other modifiers (for extensor mechanism injuries and open injuries) used in the KD classification and on which MLKIs were dislocations was not available for the individuals in this study, but should be included in future studies 16,17,38 .…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…In the context of KD5 injuries (KD + periarticular fracture), Stannard et al recommended modifying the classification further to delineate ligament damage by adding a suffix to indicate which classification would be appropriate if the fracture was not present 25 . Similarly, a recent Delphi panel suggested the inclusion of an additional “-O” modifier to indicate open injuries 26 . Adding EM injuries as a “sixth stratified level” has been previously suggested by Mojica et al 7 .…”

Section: Discussionmentioning

confidence: 99%

Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

Medvecky

Kahan

Richter

et al. 2023

Journal of Bone and Joint Surgery

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Background: Multiligament knee injury (MLKI) with associated extensor mechanism (EM) involvement is a rare injury, with limited evidence to guide optimal treatment. The purpose of this study was to identify areas of consensus among a group of international experts regarding the treatment of patients with MLKI and concomitant EM injury.Methods: Utilizing a classic Delphi technique, an international group of 46 surgeons from 6 continents with expertise in MLKI undertook 3 rounds of online surveys. Participants were presented with clinical scenarios involving EM disruption in association with MLKI, classified using the Schenck Knee-Dislocation (KD) Classification. Positive consensus was defined as ‡70% agreement with responses of either "strongly agree" or "agree," and negative consensus was defined as ‡70% agreement with "strongly disagree" or "disagree."Results: There was a 100% response rate for rounds 1 and 2 and a 96% response rate for round 3. There was strong positive consensus (87%) that an EM injury in combination with MLKI significantly alters the treatment algorithm. For an EM injury in conjunction with a KD2, KD3M, or KD3L injury, there was positive consensus to repair the EM injury only and negative consensus regarding performing concurrent ligamentous reconstruction at the time of initial surgery. Conclusions:In the setting of bicruciate MLKI, there was overall agreement on the significant impact of EM injury on the treatment algorithm. We therefore recommend that the Schenck KD Classification be updated with the addition of the modifier suffix "-EM" to highlight this impact. Treatment of the EM injury was judged to have the highest priority, and there was consensus to treat the EM injury only. However, given the lack of clinical outcome data, treatment decisions need to be made on a case-by-case basis with consideration of the numerous clinical factors that are encountered.Clinical Relevance: Little clinical evidence exists to guide the surgeon on the management of EM injury in the setting of a multiligament injured or dislocated knee. This survey highlights the impact that EM injury has on the treatment algorithm and provides some guidance for management until a further large case series or prospective studies are undertaken. *A list of the Knee Fracture-Dislocation Study Group members is included in a note at the end of the article.

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Prognostic Factors for Multiligament Knee Injury Treated With Multiligament Reconstruction: Functional and Radiological Outcomes at 2 to 8 Years Postoperatively

Schneebeli,

Philippe,

Laurent

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Multiligament reconstruction (MLR) has become the standard surgical approach for treating multiligament knee injuries (MLKIs). Purpose: To identify prognostic factors for patient-reported outcome measures, return to work (RTW), return to sports, and radiographic osteoarthritis (OA) (Kellgren-Lawrence grade ≥2) after MLR for MLKI. Study Design: Case-control study; Level of evidence 3. Methods: Included were 52 consecutive patients (age, 35.5 ± 11 years; 75% men), with MLKI sustained between 2013 and 2019 and treated with MLR. At a mean follow-up of 3.8 ± 1.6 years, patient-reported outcome measure scores—including the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), and the 12-Item Short-Form Health Survey—RTW, return to sports, and weightbearing radiographs were obtained. A total of 20 determinants were hypothesized and tested by univariate logistic regression for binary variables or linear regression for continuous variables. Only factors identified as significant ( P < .10) were entered into a multivariate logistic regression model. Results: The prevalence of injury severity according to the Schenck knee dislocation (KD) classification was as follows: KD I (44%), KD III (36%), KD IV (10%), and KD V (10%). Increased KD grades resulted in decreased IKDC ( P = .002) and all 5 KOOS subscales ( P≤ .007 for all) scores. Medial meniscectomy (23%) was associated with a worse ACL-RSI score ( P = .007) and RTW failure (odds ratio [OR], 36.8; P = .035). Peroneal nerve palsy (6%) was associated with a worse ACL-RSI score ( P≤ .001). Radiographic OA was observed in 38%, with distribution predominantly patellofemoral (80%) and medial tibiofemoral (45%). Traumatic cartilage damage (Outerbridge grade >2 [37%]) was associated with secondary patellofemoral (OR, 10; P = .012) and medial tibiofemoral (OR, 10; P = .019) OA. Anterior cruciate ligament reconstruction failure (7%) was a risk factor for medial tibiofemoral OA (OR, 25.8; P = .006). Conclusion: Increased Schenck KD grade, permanent peroneal nerve palsy, and irreparable medial meniscus lesions were prognostic factors for worse functional outcomes 3.8 years after MLKI was treated with MLR. Traumatic cartilage damage and anterior cruciate ligament failure were associated with the development of early OA.

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Inclusion of open injuries in an updated Schenck classification of knee dislocations based on a global Delphi consensus study

Cited by 4 publications

References 27 publications

Presentation and Surgical Management of Multiple Ligament Knee Injuries

Presentation and Surgical Management of Multiple Ligament Knee Injuries

Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

Prognostic Factors for Multiligament Knee Injury Treated With Multiligament Reconstruction: Functional and Radiological Outcomes at 2 to 8 Years Postoperatively

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