scholarly journals The Multiligament Knee Injury Classification Stratifies Patients into Risk Categories

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.

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

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770652 ◽  
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.

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

2018 ◽  
Vol 32 (06) ◽  
pp. 560-564 ◽  
Author(s):  
John R. Worley ◽  
Olubusola Brimmo ◽  
Clayton W. Nuelle ◽  
James L. Cook ◽  
James P. Stannard
Keyword(s):  
Return To Work ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Knee Injuries ◽  
Knee Reconstruction ◽  
Level Of Activity ◽  
Previous Level ◽  
Peroneal Nerve Injury ◽  
Multiligament Knee Injuries

AbstractThe purpose of this study was to determine incidence of concurrent peroneal nerve injury and to compare outcomes in patients with and without peroneal nerve injury after surgical treatment for multiligament knee injuries (MLKIs). A retrospective study of 357 MLKIs was conducted. Patients with two or more knee ligaments requiring surgical reconstruction were included. Mean follow-up was 35 months (0–117). Incidence of concurrent peroneal nerve injury was noted and patients with and without nerve injury were evaluated for outcomes. Concurrent peroneal nerve injury occurred in 68 patients (19%). In patients with nerve injury, 45 (73%) returned to full duty at work; 193 (81%) patients without nerve injury returned to full duty (p = 0.06). In patients with nerve injury, 37 (60%) returned to their previous level of activity; 148 (62%) patients without nerve injury returned to their previous level of activity (p = 0.41). At final follow-up, there were no significant differences in level of pain (mean visual analog scale 1.6 vs. 2; p = 0.17), Lysholm score (mean 88.6 vs. 88.8; p = 0.94), or International Knee Documentation Committee score (mean 46.2 vs. 47.8; p = 0.67) for patients with or without peroneal nerve injury, respectively. Postoperative range of motion (ROM) (mean 121 degrees) was significantly lower (p = 0.02) for patients with nerve injury compared with patients without nerve injury (mean 127 degrees). Concurrent peroneal nerve injury occurred in 19% of patients in this large cohort suffering MLKIs. After knee reconstruction surgery, patients with concurrent peroneal nerve injuries had significantly lower knee ROM and trended toward a lower rate of return to work. However, outcomes with respect to activity level, pain, and function were not significantly different between the two groups. This study contributes to our understanding of patient outcomes in patients with concurrent MLKI and peroneal nerve injury, with a focus on the patient's ability to return to work and sporting activity.

Multiple Ligament Knee Injuries: Does the Knee Dislocation Classification Predict the Type of Surgical Management?

2020 ◽  
Author(s):  
Garrett T. Maxwell ◽  
Ryan J. Warth ◽  
Adeet Amin ◽  
Matthew A. Darlow ◽  
Lane Bailey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Management ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Knee Injuries ◽  
Knee Dislocation ◽  
Operative Management ◽  
Injury Patterns ◽  
Ligamentous Injury ◽  
The Mean

AbstractThis study aims to evaluate relationships among multiple ligament knee injury (MLKI) patterns as classified according to the knee dislocation (KD) classification and the types of surgical management pursued. We hypothesized that the KD classification would not be predictive of the types of surgical management, and that categorizing injuries according to additional injury features such as structure, chronicity, grade, and topographic location would be predictive of the types of surgical management. This is a Retrospective cohort study. This study was conducted at a level I trauma center with a 150-mile coverage radius. Query of our billing database was performed using combinations of 43 billing codes (International Classification of Diseases [ICD] 9, ICD-10, and Current Procedural Terminology) to identify patients from 2011 to 2015 who underwent operative management for MLKIs. There were operative or nonoperative treatment for individual ligamentous injuries, repair, or reconstruction of individual ligamentous injuries, and staging or nonstaging or nonstaging of each surgical procedure. The main outcome was the nature and timing of clinical management for specific ligamentous injury patterns. In total, 287 patients were included in this study; there were 199 males (69.3%), the mean age was 30.2 years (SD: 14.0), and the mean BMI was 28.8 kg/m2 (SD: 7.4). There were 212 injuries (73.9%) categorized as either KD-I or KD-V. The KD classification alone was not predictive of surgery timing, staging, or any type of intervention for any injured ligament (p > 0.05). Recategorization of injury patterns according to structure, chronicity, grade, and location revealed the following: partial non-ACL injuries were more frequently repaired primarily (p < 0.001), distal medial-sided injuries were more frequently treated operatively than proximal medial-sided injuries (odds ratio [OR] = 24.7; p <0.0001), and staging was more frequent for combined PCL-lateral injuries (OR = 1.3; p = 0.003) and nonavulsive fractures (OR = 1.2; p = 0.0009). The KD classification in isolation was not predictive of any surgical management strategy. Surgical management was predictable when specifying the grade and topographic location of each ligamentous injury. This is a Level IV, retrospective cohort study.

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

2020 ◽  
Vol 48 (14) ◽  
pp. 3541-3548
Author(s):  
Joseph B. Kahan ◽  
Don Li ◽  
Christopher A. Schneble ◽  
Patrick Huang ◽  
James Bullock ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Peroneal Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
Lateral Collateral Ligament ◽  
Posterolateral Corner ◽  
Peroneal Nerve Palsy ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
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.

Peroneal nerve injury associated with sports-related knee injury

2011 ◽  
Vol 31 (5) ◽  
pp. E11 ◽  
Author(s):  
Dosang Cho ◽  
Kriangsak Saetia ◽  
Sangkook Lee ◽  
David G. Kline ◽  
Daniel H. Kim
Keyword(s):  
Nerve Injury ◽  
Peroneal Nerve ◽  
Nerve Repair ◽  
Knee Injuries ◽  
Ice Hockey ◽  
Fracture Dislocation ◽  
Nerve Injuries ◽  
Surgical Interventions ◽  
Peroneal Nerve Injury ◽  
Graft Length

Object This study analyzes 84 cases of peroneal nerve injuries associated with sports-related knee injuries and their surgical outcome and management. Methods The authors retrospectively reviewed the cases of peroneal nerve injury associated with sports between the years 1970 and 2010. Each patient was evaluated for injury mechanism, preoperative neurological status, electrophysiological studies, lesion type, and operative technique (neurolysis and graft repair). Preoperative status of injury was evaluated by using a grading system published by the senior authors. All lesions in continuity had intraoperative nerve action potential recordings. Results Eighty-four (approximately 18%) of 448 cases of peroneal nerve injury were found to be sports related, which included skiing (42 cases), football (23 cases), soccer (8 cases), basketball (6 cases), ice hockey (2 cases), track (2 cases) and volleyball (1 case). Of these 84 cases, 48 were identified as not having fracture/dislocation and 36 cases were identified with fracture/dislocation for surgical interventions. Good functional outcomes from graft repair of graft length < 6 cm (70%) and neurolysis (85%) in low-intensity peroneal nerve injuries associated with sports were obtained. Recovery from graft repair of graft length between 6 and 12 cm (43%) was good and measured between Grades 3 and 4. However, recovery from graft repair of graft length between 13 and 24 cm was obtained in only 25% of patients. Conclusions Traumatic knee-level peroneal nerve injury due to sports is usually associated with stretch/contusion, which more often requires graft repair. Graft length is the factor to be considered for the prognosis of nerve repair.

scholarly journals Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

2014 ◽  
Vol 472 (9) ◽  
pp. 2630-2636 ◽  
Author(s):  
Aaron J. Krych ◽  
Steven A. Giuseffi ◽  
Scott A. Kuzma ◽  
Michael J. Stuart ◽  
Bruce A. Levy
Keyword(s):  
Nerve Injury ◽  
Peroneal Nerve ◽  
Knee Dislocation ◽  
Peroneal Nerve Injury

scholarly journals Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation

2011 ◽  
Vol 470 (3) ◽  
pp. 774-778 ◽  
Author(s):  
Christopher J. Peskun ◽  
Jas Chahal ◽  
Zvi Y. Steinfeld ◽  
Daniel B. Whelan
Keyword(s):  
Risk Factors ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Knee Dislocation ◽  
Peroneal Nerve Injury
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