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. 2018 Sep;26(9):2865-2871.
doi: 10.1007/s00167-017-4784-3. Epub 2017 Nov 29.

Poly-traumatic multi-ligament knee injuries: is the knee the limiting factor?

Jarret M Woodmass  1 , Nick R Johnson  1 , Rohith Mohan  1 , Aaron J Krych  1 , Bruce A Levy  2 , Michael J Stuart  1
Affiliations

Poly-traumatic multi-ligament knee injuries: is the knee the limiting factor?

Jarret M Woodmass et al. Knee Surg Sports Traumatol Arthrosc. 2018 Sep.

Abstract

Purpose: Multi-ligament knee injuries (MLKI) from a high-velocity accident are rare but potentially devastating. This matched cohort analysis compares knee functional outcomes after multiple ligament reconstruction in poly-trauma patients to those that occurred in isolation.

Methods: Sixty-two patients with MLKI that occurred either as a component of polytrauma or had occurred in isolation were matched according to age, sex, and knee dislocation grade. Functional outcomes and knee physical examination were assessed at a 2-year follow-up. New Injury Severity Score (NISS) was calculated based on the poly-traumatic injury pattern. Risk factors for worse outcomes in the poly-trauma cohort were analyzed.

Results: The mean IKDC, Lysholm, and NISS scores in the polytrauma cohort were 57.2 ± 21.9, 62 ± 22, and 40.9 ± 20.4, respectively, at a mean of 67 months (range 24-220). The isolated knee injury group was followed for a mean of 74 months (range 24-266) with mean IKDC and Lysholm scores of 71.1 ± 26.5 and 78 ± 23, respectively. Patients in the control cohort had significantly higher IKDC (p = 0.01) and Lysholm scores, (p = 0.003). There were no major differences between the two groups in regards physical examination findings at final follow-up. None of the analyzed risk factors was predictive of poor outcome.

Conclusion: When comparing knees with similar multi-ligament and neurovascular injury patterns, patients who sustained their injury as a result of poly-trauma demonstrated significantly lower functional scores following reconstruction. This is despite restoration of similar knee stability and range of motion. The functional outcomes following MLKI reconstruction in poly-traumatized patients are influenced by factors other than the knee including concomitant injuries and psychosocial factors.

Level of evidence: Therapeutic Level III.

Keywords: Knee dislocation; Multi-ligament knee injury (MLKI); Multi-ligament reconstruction; Poly-trauma.

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