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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2015

01.10.2015 | Knee

Surgical treatment of multiligament knee injuries

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

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 10/2015

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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.
Literatur
1.
Zurück zum Zitat Almekinders LC, Logan TC (1992) Results following treatment of traumatic dislocations of the knee joint. Clin Orthop Relat Res 284:203–207PubMed Almekinders LC, Logan TC (1992) Results following treatment of traumatic dislocations of the knee joint. Clin Orthop Relat Res 284:203–207PubMed
2.
Zurück zum Zitat 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 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
3.
Zurück zum Zitat Azar FM, Brandt JC, Miller RH, Phillips BB (2011) Ultra-low-velocity knee dislocations. Am J Sports Med 39(10):2170–2174CrossRefPubMed Azar FM, Brandt JC, Miller RH, Phillips BB (2011) Ultra-low-velocity knee dislocations. Am J Sports Med 39(10):2170–2174CrossRefPubMed
4.
Zurück zum Zitat 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 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
5.
Zurück zum Zitat 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 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
6.
Zurück zum Zitat Cush G, Irgit K (2011) Drop foot after knee dislocation: evaluation and treatment. Sports Med Arthrosc 19(2):139–146CrossRefPubMed Cush G, Irgit K (2011) Drop foot after knee dislocation: evaluation and treatment. Sports Med Arthrosc 19(2):139–146CrossRefPubMed
7.
Zurück zum Zitat Dwyer T, Marx RG, Whelan D (2012) Outcomes of treatment of multiple ligament knee injuries. J Knee Surg 25(4):317–326CrossRefPubMed Dwyer T, Marx RG, Whelan D (2012) Outcomes of treatment of multiple ligament knee injuries. J Knee Surg 25(4):317–326CrossRefPubMed
8.
Zurück zum Zitat 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 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
9.
Zurück zum Zitat 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 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.
Zurück zum Zitat Good L, Johnson RJ (1995) The dislocated knee. J Am Acad Orthop Surg 3(5):284–292PubMed Good L, Johnson RJ (1995) The dislocated knee. J Am Acad Orthop Surg 3(5):284–292PubMed
11.
Zurück zum Zitat Graf B, Uhr F (1988) Complications of intra-articular anterior cruciate reconstruction. Clin Sports Med 7(4):835–848PubMed Graf B, Uhr F (1988) Complications of intra-articular anterior cruciate reconstruction. Clin Sports Med 7(4):835–848PubMed
12.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Kennedy J (1963) Complete dislocation of the knee joint. J Bone Joint Surg Br 45(5):889–904 Kennedy J (1963) Complete dislocation of the knee joint. J Bone Joint Surg Br 45(5):889–904
17.
Zurück zum Zitat 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 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.
Zurück zum Zitat Levy BA, Stuart MJ (2012) Treatment of PCL, ACL, and lateral-side knee injuries: acute and chronic. J Knee Surg 25(4):295–305CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Manske RC, Hosseinzadeh P, Giangarra CE (2008) Multiple ligament knee injury: complications. N Am J Sports Phys Ther 3(4):226–233PubMedCentralPubMed Manske RC, Hosseinzadeh P, Giangarra CE (2008) Multiple ligament knee injury: complications. N Am J Sports Phys Ther 3(4):226–233PubMedCentralPubMed
21.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Merritt AL, Wahl C (2011) Initial assessment of the acute and chronic multiple-ligament injured (dislocated) knee. Sports Med Arthrosc 19(2):93–103CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Peltola EK, Lindahl J, Hietaranta H, Koskinen SK (2009) Knee dislocation in overweight patients. Am J Roentgenol 192(1):101–106CrossRef Peltola EK, Lindahl J, Hietaranta H, Koskinen SK (2009) Knee dislocation in overweight patients. Am J Roentgenol 192(1):101–106CrossRef
29.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Schenck RC Jr (1994) The dislocated knee. Instr Course Lect 43:127–136PubMed Schenck RC Jr (1994) The dislocated knee. Instr Course Lect 43:127–136PubMed
35.
Zurück zum Zitat 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 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.
Zurück zum Zitat Shelbourne KD, Pritchard J, Rettig AC, McCarroll JR, Vanmeter CD (1992) Knee dislocations with intact PCL. Orthop Rev 21(5):607–608 610–601PubMed 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.
Zurück zum Zitat Shields L, Mital M, Cave EF (1969) Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 9:192–215CrossRefPubMed Shields L, Mital M, Cave EF (1969) Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 9:192–215CrossRefPubMed
38.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Wascher DC (2000) High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med 19(3):457–477CrossRefPubMed Wascher DC (2000) High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med 19(3):457–477CrossRefPubMed
43.
Zurück zum Zitat 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 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.
Zurück zum Zitat Wascher DC, Dvirnak PC, DeCoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11(7):525–529CrossRefPubMed Wascher DC, Dvirnak PC, DeCoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11(7):525–529CrossRefPubMed
45.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
Metadaten
Titel
Surgical treatment of multiligament knee injuries
verfasst von
Shane Cook
T. J. Ridley
Mark A. McCarthy
Yubo Gao
Brian R. Wolf
Annunziato Amendola
Matthew J. Bollier
Publikationsdatum
01.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 10/2015
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3451-1

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