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.

中文翻译：

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膝关节多处韧带损伤的表现和手术治疗：来自 MLKIs 网络的手术时机和康复 (STaR) 试验的多中心研究

背景： 

膝关节多韧带损伤 (MLK​​I) 代表了一系列损伤模式，通常与伴随的肌肉骨骼和神经血管损伤、复杂的治疗和术后并发症相关。然而，尚无高级证据描述 MLKI 的表现和治疗。这项多中心回顾性研究的目的是使用基于申克膝关节脱位分类系统的病理解剖学 MLKI 分类系统来描述 MLKI 的特征、其治疗和相关并发症。

方法： 

本综述识别并分析了 2011 年至 2015 年间发生的 MLKI。如果 ≥2 条韧带完全撕裂且至少 1 条韧带被修复或重建，则将 MLKI 病例纳入本研究。由于韧带部分撕裂而被认为临床上无功能并需要手术修复或重建的病例被认为相当于 III 级撕裂以进行纳入和分类。收集了人口统计信息、损伤机制、从受伤到就诊到整形外科医生和手术的时间、韧带损伤模式、相关损伤、手术过程和并发症。对数据进行描述性分析。

结果： 

共有来自 14 个中心的 773 名接受 MLKI 手术的患者接受了审查。这些人的平均年龄为 30.5 ± 12.7 岁，其中 74.2% 为男性。最常见的机制涉及运动（43.2%）。从受伤到就诊于骨科医生的中位时间为 11 天（四分位距 [IQR]，3 至 48 天），初次韧带手术的时间为 64 天（IQR，23 至 190 天）。虽然最常见的损伤模式是前十字韧带撕裂合并内侧损伤（MLK 1-AM，20.7%）或外侧损伤（MLK 1-AL，23.2%），但三分之一（34.7%）是双十字损伤。相关损伤最常涉及半月板（55.6%）、神经（18.5%）和肌腱（15.6%）。手术干预的方法（修复与重建）、外固定器的使用、程序的分期因 MLKI 分类而异。运动丧失（11.4%）是最常见的术后并发症。

结论： 

更好地了解各种 MLKI 模式的临床特征和管理可用于支持这些复杂损伤的临床决策和个体化治疗，并可能最终改善结果并降低相关风险。

证据级别： 

治疗等级IV。有关证据级别的完整描述，请参阅作者须知。