Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2015 | Knee

Surgical treatment of multiligament knee injuries

Authors: Shane Cook, T. J. Ridley, Mark A. McCarthy, Yubo Gao, Brian R. Wolf, Annunziato Amendola, Matthew J. Bollier

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2015

Abstract

Purpose

To analyse one institution’s experience with multiligament knee injuries.

Methods

Over 10 years, 133 multiligament knee injuries including 130 patients were included in the study. Inclusion criteria included: (1) injury to two or more knee ligaments (2) multiligament knee repair/reconstructive surgery.

Results

The average age at time of injury was 26 years old, and 76 % were male. Fifty-one (38 %) multiligament knee injuries had >2 ligaments injured. Peroneal injuries occurred in 26 patients (20 %), and four (3 %) had associated vascular injuries. A high energy mechanism of injury was noted in 39 %. Twenty-five per cent of patients had an additional orthopaedic injury and, 11.5 % suffered additional non-orthopaedic injuries. Definitive surgical intervention was performed acutely (<3 weeks) in 47 %. Ninety-one per cent of multiligament knee injuries underwent reconstruction with or without repair. Forty-three complications occurred in 37 patients. Patients who suffered >2 ligament injury or had surgery acutely were at an increased risk of knee stiffness requiring manipulation under anaesthesia (MUA) (p = 0.016 and p = 0.047, respectively). Knees with >2 ligaments injured were associated with higher post-operative complications (p = 0.007). Knee dislocation IV knees were at increased risk to undergo revision surgery (p = 0.041). Obese patients were more likely to have a post-operative infection (p = 0.038). Repair, reconstruction or type of graft used had no impact on need for revision surgery.

Conclusions

Multiligament knee injured patients undergoing surgical intervention are a highly complex patient population. This study outlines the patient population, treatment, and complications of one academic institution over 10 years. Overall complications were higher in patients with >2 ligaments injured. Knee stiffness requiring MUA was more common in patients who had >2 ligaments ruptured and those treated acutely. Knees with all four ligaments injured were more likely to undergo revision surgery.

Level of evidence

Retrospective case series, Level IV.

Almekinders LC, Logan TC (1992) Results following treatment of traumatic dislocations of the knee joint. Clin Orthop Relat Res 284:203–207PubMed

Arom GA, Yeranosian MG, Petrigliano FA, Terrell RD, McAllister DR (2013) The changing demographics of knee dislocation: a retrospective database review. Clin Orthop Relat Res 472(9):2609–2614PubMedCentralCrossRef

Azar FM, Brandt JC, Miller RH, Phillips BB (2011) Ultra-low-velocity knee dislocations. Am J Sports Med 39(10):2170–2174CrossRefPubMed

Becker EH, Watson JD, Dreese JC (2013) Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. Orthop Trauma 27(4):226–231

Born TR, Engasser WM, King AH, Krych AJ, Dahm DL, Levy BA, Stuart MJ (2014) Low frequency of symptomatic venous thromboembolism after multiligamentous knee reconstruction with thromboprophylaxis. Clin Orthop Relat Res 472(9):2705–2711PubMedCentralCrossRefPubMed

Cush G, Irgit K (2011) Drop foot after knee dislocation: evaluation and treatment. Sports Med Arthrosc 19(2):139–146CrossRefPubMed

Dwyer T, Marx RG, Whelan D (2012) Outcomes of treatment of multiple ligament knee injuries. J Knee Surg 25(4):317–326CrossRefPubMed

Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S (2009) Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc 17(9):1013–1026CrossRefPubMed

Giuseffi SA, Bishop AT, Shin AY, Dahm DL, Stuart MJ, Levy BA (2010) Surgical treatment of peroneal nerve palsy after knee dislocation. Knee Surg Sports Traumatol Arthrosc 18(11):1583–1586CrossRefPubMed

10.

Good L, Johnson RJ (1995) The dislocated knee. J Am Acad Orthop Surg 3(5):284–292PubMed

11.

Graf B, Uhr F (1988) Complications of intra-articular anterior cruciate reconstruction. Clin Sports Med 7(4):835–848PubMed

12.

Gwathmey FW, Shafique DA, Miller MD (2010) Our approach to the management of the multiple-ligament knee injury. Oper Tech Sports Med 18(4):235–244CrossRef

13.

Conwell HE, Alldredge RH (1937) Complete dislocations of the knee joint: a report of seven cases with end results. Surg Gynecol Obstet 64:94–101

14.

Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ (2004) Surgical management of knee dislocations. J Bone Joint Surg Am 86-a(2):262–273PubMed

15.

Helgeson MD, Lehman RA Jr, Murphy KP (2005) Initial evaluation of the acute and chronic multiple ligament injured knee. J Knee Surg 18(3):213–219PubMed

16.

Kennedy J (1963) Complete dislocation of the knee joint. J Bone Joint Surg Br 45(5):889–904

17.

Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25(4):430–438CrossRefPubMed

18.

Levy BA, Stuart MJ (2012) Treatment of PCL, ACL, and lateral-side knee injuries: acute and chronic. J Knee Surg 25(4):295–305CrossRefPubMed

19.

Lustig S, Leray E, Boisrenoult P, Trojani C, Laffargue P, Saragaglia D, Rosset P, Neyret P, French Society of Orthopedic S, Traumatology (2009) Dislocation and bicruciate lesions of the knee: epidemiology and acute stage assessment in a prospective series. Orthop Traumatol Surg Res 8:614–620CrossRef

20.

Manske RC, Hosseinzadeh P, Giangarra CE (2008) Multiple ligament knee injury: complications. N Am J Sports Phys Ther 3(4):226–233PubMedCentralPubMed

21.

Mariani PP, Santoriello P, Iannone S, Condello V, Adriani E (1999) Comparison of surgical treatments for knee dislocation. J Knee Surg 12(4):214–221

22.

Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR (2014) Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 472(9):2621–2629PubMedCentralCrossRefPubMed

23.

Merritt AL, Wahl C (2011) Initial assessment of the acute and chronic multiple-ligament injured (dislocated) knee. Sports Med Arthrosc 19(2):93–103CrossRefPubMed

24.

Mook WR, Miller MD, Diduch DR, Hertel J, Boachie-Adjei Y, Hart JM (2009) Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am 91(12):2946–2957CrossRefPubMed

25.

Niall DM, Nutton RW, Keating JF (2005) Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br 87(5):664–667CrossRefPubMed

26.

Noyes FR, Barber-Westin SD (1997) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 25(6):769–778CrossRefPubMed

27.

O’Donoghue DH (1955) An analysis of end results of surgical treatment of major injuries to the ligaments of the knee. J Bone Joint Surg Am 37(1):1–124PubMed

28.

Peltola EK, Lindahl J, Hietaranta H, Koskinen SK (2009) Knee dislocation in overweight patients. Am J Roentgenol 192(1):101–106CrossRef

29.

Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB (2012) Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop Relat Res 470(3):774–778PubMedCentralCrossRefPubMed

30.

Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C (2002) Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 30(5):718–727PubMed

31.

Ridley TJ, Cook S, Bollier M, McCarthy M, Wolf B, Amendola A (2014) Effect of body mass index on patients with multiligamentous knee injuries. Arthroscopy 30(11):1447–1452CrossRefPubMed

32.

Rihn JA, Groff YJ, Harner CD, Cha PS (2004) The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 12(5):334–346PubMed

33.

Ríos A, Villa A, Fahandezh H, de José C, Vaquero J (2003) Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma 55(3):489–494CrossRefPubMed

34.

Schenck RC Jr (1994) The dislocated knee. Instr Course Lect 43:127–136PubMed

35.

Shapiro MS, Freedman EL (1995) Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med 23(5):580–587CrossRefPubMed

36.

Shelbourne KD, Pritchard J, Rettig AC, McCarroll JR, Vanmeter CD (1992) Knee dislocations with intact PCL. Orthop Rev 21(5):607–608 610–601PubMed

37.

Shields L, Mital M, Cave EF (1969) Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 9:192–215CrossRefPubMed

38.

Sillanpaa PJ, Kannus P, Niemi ST, Rolf C, Fellander-Tsai L, Mattila VM (2014) Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study. J Trauma Acute Care Surg 76(3):715–719CrossRefPubMed

39.

Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33(6):881–888CrossRefPubMed

40.

Stannard JP, Jackson SR, Fanelli GC (2010) Knee dislocations and fracture-dislocations. In: Green DP (ed) Rockwood and Greens fractures in adults, vol 2. Lippincott, Williams & Wilkins, Philadelphia, pp 1832–1866

41.

Twaddle BC, Bidwell TA, Chapman JR (2003) Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 17(3):198–202CrossRefPubMed

42.

Wascher DC (2000) High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med 19(3):457–477CrossRefPubMed

43.

Wascher DC, Becker JR, Dexter JG, Blevins FT (1999) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med 27(2):189–196PubMed

44.

Wascher DC, Dvirnak PC, DeCoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11(7):525–529CrossRefPubMed

45.

Werner BC, Gwathmey FW Jr, Higgins ST, Hart JM, Miller MD (2013) Ultra-low velocity knee dislocations: patient characteristics, complications, and outcomes. Am J Sports Med 42(2):358–363CrossRefPubMed

46.

Wong CH, Tan JL, Chang HC, Khin LW, Low CO (2004) Knee dislocations—a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc 12(6):540–544CrossRefPubMed

Title: Surgical treatment of multiligament knee injuries
Authors: Shane Cook
T. J. Ridley
Mark A. McCarthy
Yubo Gao
Brian R. Wolf
Annunziato Amendola
Matthew J. Bollier
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-014-3451-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Surgical treatment of multiligament knee injuries

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 10/2015

Understand, respect and restore anatomy as close as possible!

Simultaneous bilateral multiligamentous knee injuries are associated with more severe multisystem trauma compared to unilateral injuries

Subclinical cartilage degeneration in young athletes with posterior cruciate ligament injuries detected with T1ρ magnetic resonance imaging mapping

Combined anterior and rotational knee laxity measurements improve the diagnosis of anterior cruciate ligament injuries

Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?

Morphology of the femoral insertion of the lateral collateral ligament and popliteus tendon