Patient-Reported Outcomes After Multiligament Knee Injury

Hanley, Jessica M.; Anthony, Christopher A.; DeMik, David E.; Glass, Natalie; Amendola, Annunziato; Wolf, Brian R.; Bollier, Matthew

doi:10.1177/2325967117694818

Cited by 27 publications

(26 citation statements)

References 27 publications

(43 reference statements)

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“…28 The subjective IKDC score has been used in the past to evaluate postoperative MCL injury patients. 29 Hanley et al identified 34 patients who underwent either MCL repair or reconstruction in the setting of MLI with long term follow-up. They found a mean subjective IKDC score of 79.1 (p ¼ 0.005) in those patients who underwent repair compared to 54.3 (p ¼ 0.006) in those undergoing reconstruction at an average of 6 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…They found a mean subjective IKDC score of 79.1 (p ¼ 0.005) in those patients who underwent repair compared to 54.3 (p ¼ 0.006) in those undergoing reconstruction at an average of 6 years of follow-up. 29 Kovachevich et al reviewed the literature on operative management of MCL injury, specifically comparing repair to reconstruction. Their systematic review demonstrated satisfactory results in both repair and reconstruction across eight included studies.…”

Section: Discussionmentioning

confidence: 99%

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Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries

Desai

Camp

et al. 2019

J Knee Surg

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AbstractThere is limited evidence guiding management of medial collateral ligament (MCL) avulsions or functional disruptions distal to the medial joint line. This study aims to determine outcomes of a series of patients with grade III distal MCL injuries managed with acute surgical repair. Patients with grade III, distal MCL injuries, with or without multiligament involvement were identified. Demographic, clinical examination, and midterm patient-reported outcomes (PRO) data were collected. Clinical follow-up included physical examination and ligamentous stress testing at a minimum of 6 months. PROs included Lysholm's knee scoring scale, Tegner's activity score, and subjective International Knee Documentation Committee (IKDC) scores at minimum of 2 years follow-up. Of the 24 eligible patients, outcomes data were available for 20 (83%). Of the 20 included patients, 16 had a concomitant anterior cruciate ligament (ACL) injury, 3 had ACL and posterior cruciate ligament (PCL) injuries, and 1 had an isolated MCL injury. Mean time from injury to surgery was 5 weeks. At mean clinical follow-up of 20.3 months, all patients showed valgus stability and satisfactory range of motion (ROM). Anteroposterior stability was normal in all but one patient who demonstrated a 2+ posterior drawer but with firm end points. At a mean follow-up of 5.7 years for PROs, mean Lysholm's score was 91.5 (standard deviation [SD] = 12.2), median Tegner's activity score was 7 (range, 4–9), and mean subjective IKDC score was 88.8 (SD: 9.9). The surgical repair of grade III distal MCL injuries delivered satisfactory clinical and functional outcomes. Future comparative studies with larger patient samples are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries

Desai

Camp

et al. 2019

J Knee Surg

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“…The mechanism of injury was deemed high energy if occurring in a motor vehicle or motorcycle collision, pedestrian versus motor vehicle, all-terrain vehicle accidents, or fall from height greater than 5 feet. 1 All other injuries were deemed low energy in nature. Time to surgery was evaluated to determine whether injury chronicity was associated with cartilage or meniscus damage.…”

Section: Methodsmentioning

confidence: 99%

Cartilage and Meniscus Injuries Are More Common in Patients Undergoing Delayed Multiligament Reconstruction

et al. 2020

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The purpose of this study was to describe the pattern of meniscus and cartilage pathology in multiligament knee injuries (MLKIs) and determine the relationship between surgical timing and injury mechanism with degree of intra-articular injury. Patients with surgically treated MLKIs over a 15-year period were retrospectively reviewed and grouped based on surgical intervention, time to intervention, and injury mechanism. The presence or absence of meniscus and chondral injury were recorded at the time of surgery. Surgical intervention within 6 weeks of injury was deemed acute, while surgery occurring more than 6 weeks from injury was classified as delayed. Over the 15-year study period, 207 patients with MLKIs were identified. Compared with acutely managed patients, the delayed intervention group had significantly more meniscus (p = 0.03) and cartilage (p < 0.01) pathology. Meniscus injury rates in MLKIs sustained during sporting activity did not differ from nonsporting injuries (p = 0.63). However, the nonsporting group had significantly more chondral injuries (p < 0.01). High-energy injury mechanism was associated with increased cartilage (p = 0.02), but not meniscus (p = 0.61) injury rates. In conclusion, surgical reconstruction of MLKIs delayed for more than 6 weeks was associated with increased meniscus and cartilage pathology.

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“…Conversely, the disadvantage is that the adaptation is limited (i.e., damaged lesion or period after injury) [15]. Regarding indications for ligament repair, the ACL and PCL are both considered to be injured in proximal lesions [16,17], and the MCL is considered injured in proximal or distal lesions [18]. In this case, the ACL, PCL, and MCL were also all injured proximally.…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

Murakami

Honda

Fukai

et al. 2020

Case Reports in Orthopedics

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Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

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Patient-Reported Outcomes After Multiligament Knee Injury

Cited by 27 publications

References 27 publications

Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries

Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries

Cartilage and Meniscus Injuries Are More Common in Patients Undergoing Delayed Multiligament Reconstruction

Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

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