Lower limb fractures associated with multiligament knee injury

JBJS reviews, 2016

Multiligament knee injuries have a strong association with periarticular soft-tissue and neurovascular injuries, which must not be overlooked in the initial evaluation of the patient. Even though magnetic resonance imaging (MRI) is imperative for a complete evaluation of the damaged ligamentous knee restraints, stress radiography aids in establishing the functional consequence of the MRI findings and may assist in directing reconstruction. Although cruciate ligament tears are generally reconstructed, a combined repair-reconstruction approach is most useful for collateral ligaments and extra-articular structures, with incorporation of local tissue into the reconstruction whenever possible. Regardless of the timing and operative technique chosen, patients with multiligament knee injuries are at high risk for complications and long-term disability.

Bone & Joint Open

Aims Multiligament knee injuries (MLKI) are devastating injuries that can result in significant morbidity and time away from sport. There remains considerable variation in strategies employed for investigation, indications for operative intervention, outcome reporting, and rehabilitation following these injuries. At present no study has yet provided a comprehensive overview evaluating the extent, range, and overall summary of the published literature pertaining to MLKI. Our aim is to perform a methodologically rigorous scoping review, mapping the literature evaluating the diagnosis and management of MLKI. Methods This scoping review will address three aims: firstly, to map the current extent and nature of evidence for diagnosis and management of MLKI; secondly, to summarize and disseminate existing research findings to practitioners; and thirdly, to highlight gaps in current literature. A three-step search strategy as described by accepted methodology will be employed to identify pe...

Orthopaedics & traumatology, surgery & research : OTSR, 2013

After multiple-ligament injuries and dislocations of the knee, clinical assessment of the soft tissues is difficult and MRI is generally performed. MRI is a reliable examination, providing a precise and reproducible assessment of soft-tissue lesions after multiple-ligament injuries or dislocations of the knee. Forty patients presenting multiple-ligament lesions of the knee were included in this multicenter prospective study. All had an MRI of the knee in the 48 h following their accident. Thirty-four patients were treated surgically. A 17-item standardized interpretation guide was created. Intraobserver reproducibility was assessed by comparing the interpretations of five surgeons at two different times 3 weeks apart. Interobserver reproducibility was evaluated by comparing the results of the interpretations of 40 MRIs performed by three pairs of surgeons. The relevance of the MRI interpretations was determined by comparing the results of the surgeons to those of a radiologist and w...

Current Problems in Diagnostic Radiology, 2017

Background: We identified common morphologies of tibial plateau fractures that arise with multi-ligament knee injuries (MLKI), and investigated the relationship of the fracture with ligament tears. We also evaluated the correlation of three tibial plateau fracture classification systems (Schatzker, AO, and Duparc). Methods: Over a two-year period, a single orthopaedic surgeon at our institution managed 90 MLKI's. Images of those knees with a tibial plateau fracture were retrospectively reviewed and classified per Schatzker, AO, and Duparc systems. Correlation among the three systems was evaluated using Spearman non-parametric correlation coefficient. Associations between fracture grading system and ligament tears were estimated using logistic regression. Associations between ligament tears and tibial plateau fracture location (medial versus lateral) were estimated using exact logistic regression.

Indian Journal of Orthopaedics

Background: Multiligamentous injuries of knee remain a gray area as far as guidelines for management are concerned due to absence of large-scale, prospective controlled trials. This article reviews the recent evidence-based literature and trends in treatment of multiligamentous injuries and establishes the needful protocol, keeping in view the current concepts. Materials and Methods: Two reviewers individually assessed the available data indexed on PubMed and Medline and compiled data on incidence, surgical versus nonsurgical treatment, timing of surgery, and repair versus reconstruction of multiligamentous injury. Results: Evolving trends do not clearly describe treatment, but most studies have shown increasing inclination toward an early, staged/single surgical procedure for multiligamentous injuries involving cruciate and collateral ligaments. Medial complex injuries have shown better results with conservative treatment with surgical reconstruction of concomitant injuries. Conclusion: Multiligamentous injury still remains a gray area due to unavailability of a formal guideline to treatment in the absence of large-scale, blinded prospective controlled trials. Any in multiligamentous injuries any intervention needs to be individualized by the presence of any life-or limb-threatening complication. The risks and guarded prognosis with both surgical and nonsurgical modalities of treatment should be explained to patient and relations.

The open orthopaedics journal, 2014

Multiligamentous knee injuries are rare but serious injuries that can threaten limb viability. As such, they require careful management to give patients the best chance of immediate and ultimate functional recovery. However, as these injuries are rare, there is paucity in prospective comparative studies large enough to provide high level evidence for best practice. This lack of comprehensive and convincing evidence has made the management of multiligamentous knee injuries an area of active debate and controversy. The debate on whether surgical management leads to better outcomes than non-operative management, the optimal timing of surgery after injury and whether repair is better than reconstruction is still ongoing. Using the Oxford Levels of Evidence, this review summarises the latest high level evidence to provide answers to these issues. Recommendations for practice have also been offered and assigned a grade using a published scale.

2013

BACKGROUND: MRI has become a valuable diagnostic modality for the evaluation of knee joint. The aim of the study were to study the various traumatic consequences of knee joint injury, to study specific primary and secondary signs on MRI pertaining the specific type of injury and also to establish the continuing relevance and growing importance of MRI in evaluation of the knee joint injury and Role of MRI in operative management of the patients with knee injury. MATERIALS AND METHODS: A prospective study of 50 patients were done. Study group consist of patients who come for treatment of knee injury and undergone MRI investigation previously and afterwards. RESULTS: Meniscal injury is the most common injury seen in knee injury. Medial meniscus is more prone to injury than lateral meniscus. ACL is more prone to tear then PCL in knee injury. Associated finding with ligament injury are joint effusion, bone edema and contusion, fracture. CONCLUSION: MRI plays an important role in making a...

Background: Multiligament knee injuries are typically the result of severe trauma, and can result in loss of limb or limb function. At the present time, there is controversy regarding initial treatment and optimal surgical management. Questions/purposes: The objectives of this study were (1) tTo offer an algorithm for management of the patient with a multiligamentous injury to the knee .(2) to describe the clinical and functional outcomes of a consecutive series of patients with multiligament knee injuries managed with this approach by a single surgeon (3) to present a novel surgical technique for the treatment of multiligamentous knee injuries. Patients and Methods: We present data on sixteen consecutive knees in 16 patients, 11 male and 5 female, mean age 44 (range 24-65) years with a diagnosis of a multiligament knee injury (defined as a disruption of two or more ligaments that include the PCL). All patients underwent standard preoperative evaluation and were treated according to our algorithm for surgical reconstruction of multiligament-injured knees. Mean follow-up since surgery was 3.87 (range 2-9) years. Outcome measures were determination of range of motion, testing with KT-2000 arthrometer, and Tegner and Lysholm scores. Results: Common mechanisms of injury were MVA in 7 patients (44%) and sports in 3 patients (19%). Of the four major knee ligaments, 4 patients (25%) had two injured ligaments, 11 patients (69%) had three injured ligaments, and 1 patient (6%) had four injured ligaments. There was an associated common peroneal nerve injury in 3 patients (19%) and there were no patients with associated vascular injuries. Six patients (38%) underwent staged reconstruction, with the remainder of patients undergoing single-stage reconstruction. Following surgery, mean range of motion (ROM) in flexion was 111 (range 95-138) degrees, and mean ROM in extension was-2 (range-12-0) degrees. Mean Tegner score before injury was 6 (range 0-9) and mean Tegner activity level after reconstruction was 4 (range 1-7). Mean post-operative Lysholm score was 78 (range 30-118). Mean KT-2000 anterior manual maximum difference was 2.5 (0.3-6.7) millimeters and mean posterior difference was 2.2 (0.0-3.3) millimeters. Following surgery, one patient (6%) had symptomatic recurrent instability that required a revision. Conclusions: Our current algorithm used to treat this series of multiligament knee injuries demonstrated satisfactory clinical and functional outcomes, with few complications. An algorithmic approach to treatment as presented by the authors can minimize adverse sequellae associated with surgical treatment of multiligament knee injuries.

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018

To investigate the influence of injury and treatment factors on clinical/functional outcomes in multiligament knee injuries (MLKI). Thirty-nine consecutive patients with confirmed and surgically treated MLKI who met inclusion criteria were scheduled for a follow-up visit to obtain: SF-12 and subjective feeling of normalcy between the operated and healthy knee, and IKDC, active range of motion (ROM), and stability exam (Lachman test, posterior drawer, and dial test at 30°). A chart review was used to obtain data on injury and treatment factors. The postoperative mean (SD) outcomes were: IKDC score 62.7 (25.9), flexion-extension ROM 125° (29°), and percentage of normalcy 74% (20%). The postoperative normal/nearly normal stability exam was: Lachman test 36 (95%) patients, posterior drawer at 90° 38 (97%) patients, and dial test of 39 (100%) patients. There were 24 (61.5%) and 23 (59%) patients with complications and reoperations, respectively. The presence of bicruciate injuries was as...

Annals of International Medical and Dental Research, 2022

Background: Knee is one of the major joints involved in kinesis. With increasing involvement in sports related activities especially in young people, Trauma related knee pathologies have increased. An accurate diagnosis regarding the type and extent of injuries is essential for early operative as well as non-operative treatment. Methods:This prospective study included total of 82 cases. The patients were referred to the department of Radiodiagnosis from indoor and outdoor departments of Guru Nanak Dev Hospital, Amritsar with suspicion of internal derangement of the knee and with history of knee trauma.Results:The most common age group involved was young males between 15-34 years. In all age groups most of the patients were males. Most common ligament to be injured was Anterior Cruciate Ligament (ACL). Partial tears were more common than complete tears. Posterior Cruciate Ligament (PCL) tears were less common. Medial Collateral Ligament (MCL) tears outnumbered Lateral Collateral Liga...