The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury

Background: A description of the precise locations of ligamentous and myotendinous injury patterns of acute posterolateral corner (PLC) injuries and their associated osseous and neurovascular injuries is lacking in the literature. Purpose: To characterize the ligamentous and myotendinous injury patterns and zones of injury that occur in acute PLC injuries and determine associated rates of peroneal nerve palsies and vascular injuries, as well as fracture and dislocation. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified all patients treated for an acute multiligament knee injury (MLKI) at our level 1 trauma center from 2001 to 2018. From this cohort, all patients with PLC injuries were identified. Demographics, involved ligaments and tendons, neurovascular injury, and presence of fracture and dislocation were compared with the larger multiligament knee cohort. Incidence and location of injury of PLC structures—from proximal to midsubstance and distal injury—were recorded. Results: A total of 100 knees in 100 patients were identified as having MLKIs. A total of 74 patients (74%) had lateral-sided ligament injuries. Of these, 23 (31%) had a peroneal nerve palsy associated with their injury; 10 (14%), a vascular injury; and 23 (31%), a fracture. Patients with PLC injuries had higher rates of peroneal nerve injury as compared with those having acute MLKIs without a PLC injury (31% vs 4%; P = .005). Patients with a complete peroneal nerve palsy (n = 17) were less likely to regain function than those with a partial peroneal nerve palsy (n = 6; 12% vs 100%; P < .0001). Complete injury to the lateral collateral ligament (LCL) occurred in 71 of 74 (96%) PLC injuries, with 3 distinct patterns of injury demonstrated. Fibular avulsion of the LCL was the most common zone of injury (65%), followed by femoral avulsion (20%) and midsubstance tear (15%). Location of injury to the LCL was associated with the rate of peroneal nerve injury, with midsubstance tears and fibular avulsions associated with higher rates of peroneal nerve injury. Conclusion: MLKIs with involvement of the PLC are more likely to suffer peroneal nerve injury. The LCL is nearly always involved, and its location of injury is predictive of peroneal nerve injury. Patients with a complete peroneal nerve palsy at presentation are much less likely to regain function.

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Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117706521 ◽

2017 ◽

Vol 5 (5) ◽

pp. 232596711770652 ◽

Cited By ~ 34

Author(s):

Gilbert Moatshe ◽

Grant J. Dornan ◽

Sverre Løken ◽

Tom C. Ludvigsen ◽

Robert F. LaPrade ◽

...

Keyword(s):

Nerve Injury ◽

Peroneal Nerve ◽

Knee Dislocation ◽

Ligament Injury ◽

Associated Injuries ◽

Injury Patterns ◽

Peroneal Nerve Injury ◽

Cartilage Injuries ◽

Knee Dislocations ◽

And Cartilage

Background: Information on the incidence, injury mechanisms, ligament injury patterns, and associated injuries of knee dislocations is lacking in the literature. There is a need to characterize ligament injury patterns and associated injuries in knee dislocations to avoid missing common associated diagnoses and to plan surgical treatment. Purpose: To evaluate patient demographics, ligament injury patterns and associated injury patterns, and associated injuries in patients with knee dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 303 patients with knee dislocations treated at a single level 1 trauma center were followed prospectively. Injury mechanism; ligament injury patterns; associated neurovascular, meniscal, and cartilage injuries; and surgical complications were recorded. The Schenck knee dislocation classification was used to classify the ligament injury patterns. Results: The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female. There was an equal distribution of high-energy and low-energy injuries. Injury to 3 major ligaments was the most common, with Schenck classification type KD III-M constituting 52.4% of the injuries and KD III-L comprising 28.1%. Meniscal injuries and cartilage injuries occurred in 37.3% and 28.3% of patients, respectively. Patients with acute injuries had significantly lower odds of a cartilage injury than those with chronic injuries (odds ratio [OR], 0.28; 95% CI, 0.15-0.50; P < .001). Peroneal nerve injuries were recorded in 19.2% of patients (10.9% partial and 8.3% complete deficit), while vascular injuries were recorded in 5%. The odds of having a common peroneal nerve injury were 42 times greater ( P < .001) among those with posterolateral corner injury (KD III-L) than those without. The odds for popliteal artery injury were 9 times greater ( P = .001) among those with KD III-L injuries than other ligament injury types. Conclusion: Medial-sided bicruciate injuries were the most common injury pattern in knee dislocations. Cartilage injuries were common in chronically treated patients. There was a significant risk of peroneal nerve injury with lateral-sided injuries.

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Ski- and snowboard related open peroneal nerve injury: A 20-year retrospective case series study

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2021.102662 ◽

2021 ◽

pp. 102662

Author(s):

J. Metzler ◽

E.M. Morandi ◽

K. Schwaiger ◽

D. Wolfram ◽

T. Cakl ◽

...

Keyword(s):

Nerve Injury ◽

Peroneal Nerve ◽

Case Series ◽

Retrospective Case ◽

Retrospective Case Series ◽

Case Series Study ◽

Peroneal Nerve Injury ◽

Series Study

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The Multiligament Knee Injury Classification Stratifies Patients into Risk Categories

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00493 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0049

Author(s):

Patrick Huang ◽

Don Li ◽

Logan Petit ◽

Jack Porrino ◽

Michael Medvecky ◽

...

Keyword(s):

Nerve Injury ◽

Vascular Injury ◽

Peroneal Nerve ◽

Knee Injuries ◽

Knee Dislocation ◽

Associated Injuries ◽

Injury Patterns ◽

Ligamentous Injury ◽

Peroneal Nerve Injury ◽

Multiligament Knee Injuries

Objectives: Our goal was to characterize the precise ligamentous injury locations and patterns of acute multi-ligament knee injuries (MLKI) and determine associated rates of dislocations, fractures, peroneal nerve palsies, and vascular injuries. Methods: All patients at a single level one trauma center who received operative treatment for MLKI between 2001 and 2019 were retrospectively identified. Demographic, injury mechanism, injury patterns, presence of dislocation, and associated injuries including vascular injury, peroneal nerve palsy, and fracture were assessed for each patient. MLKI both with and without a document knee dislocation were classified into five classes based on pattern of ligamentous tear (Figure 1). Class 1 included unicruciate tear with any combination of collateral tear. Class 2 are a bicruciate tear without collateral involvement. Class 3 are bicruciate tears with either a medial or lateral sided tear. Class 4 are bicruciate tears with both medial and lateral sided tears. Class 5 are periarticular fracture with any of the preceding ligamentous injury patterns. Rates of dislocation, vascular injury and peroneal nerve injury were analyzed among each class. Single variable statistics such as t-tests as well as multivariable techniques such as Chi square and multiple regression analysis was performed to identify patterns of injury and to predict risk of associated injuries. Results: 100 knees were identified as multiligament knee injuries. 34 of the knees (34%) were dislocated at presentation, and the remaining 66 (66%) did not have a documented knee dislocation. Patients with a documented knee dislocation had higher rates of vascular injury (24% vs. 3%, p = 0.0148), but not higher rates of peroneal nerve injury (32% vs. 20%, p = 0.0863). Patients with PLC injuries had statistically higher rates of peroneal nerve injury compared to acute multiligament knee injuries without a lateral sided injury (30% vs. 3%, p = 0.005). Rates of vascular injury between MLK Class are shown in Table 1. MLK Class was found to be predictive of vascular injury, but not of peroneal nerve injury. Conclusion: We present a new classification of multiligament knee injuries with the goal of providing a more precise diagnosis to aid in the surgical planning and decision making as well as to enhance clinical outcomes research of these complicated injury patterns. By classifying these injuries into five separate classes and further subclassified based on presence of dislocation and lateral sided injury, we are better able to predict likelihood of neurovascular injury. We hope that understanding the risks associated with each class will allow physicians to better appreciate the likelihood of potential complications of these injuries.

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The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury: Letter to the Editor

The American Journal of Sports Medicine ◽

10.1177/03635465211014498 ◽

2021 ◽

Vol 49 (7) ◽

pp. NP27-NP27

Author(s):

Andy Williams

Keyword(s):

Nerve Injury ◽

Peroneal Nerve ◽

Knee Injuries ◽

Posterolateral Corner ◽

Letter To The Editor ◽

Peroneal Nerve Injury ◽

Multiligament Knee Injuries

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Surgical management of proximal fibular tumors: risk factors for recurrence and complications

Journal of International Medical Research ◽

10.1177/0300060518762677 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1884-1892

Author(s):

Changzhi Guo ◽

Xiaoran Zhang ◽

Feng Gao ◽

Lingxiang Wang ◽

Tao Sun

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Risk Factor ◽

Peroneal Nerve ◽

Nerve Palsy ◽

Independent Risk Factor ◽

Peroneal Nerve Palsy ◽

Peroneal Nerve Injury ◽

Wound Healing Problems ◽

Independent Risk Factors

Objectives The aim of this study was to identify patient- and treatment-specific independent risk factors for the recurrence of proximal fibular tumors and complications of their surgical management. Methods Patients who underwent surgical treatment of proximal fibular tumors at our institution from 2004 to 2015 were retrospectively reviewed. All patients had a pathologically confirmed diagnosis and were followed up for at least 12 months for recurrence and complications. All patients were evaluated with respect to seven patient-, disease-, and treatment-specific variables. Results In the univariate analysis, peroneal nerve palsy at presentation and malignancy were associated with an increased risk of recurrence, iatrogenic peroneal nerve injury, and wound healing problems. The multivariate analysis showed that peroneal nerve palsy at presentation was an independent risk factor for recurrence and iatrogenic peroneal nerve injury and that malignancy was an independent risk factor for wound healing problems. Conclusions Peroneal nerve palsy and malignant potential are independent risk factors for complications of surgical treatment of proximal fibular tumors. The recognition of these factors may contribute to proper management and help to prevent recurrence and postoperative complications.

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