Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm

AbstractKnee dislocations are rare but devastating injuries that can often be associated with concomitant nerve injury, most often of the common peroneal nerve. Prompt diagnosis, investigation, and appropriate treatment are important in this subset of patients. This article provides an overview of relevant injury demographics, anatomy, diagnosis, and prognosis, and suggests a treatment algorithm for nerve injury associated with multiligament knee injury.

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Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994203 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199420

Author(s):

Neel K. Patel ◽

Jayson Lian ◽

Michael Nickoli ◽

Ravi Vaswani ◽

James J. Irrgang ◽

...

Keyword(s):

Risk Factors ◽

Knee Injury ◽

Treatment Algorithm ◽

Significant Risk ◽

Timing Of Surgery ◽

Surgical Reconstruction ◽

Fisher Exact Test ◽

Initial Surgery ◽

Multiligament Knee Injury ◽

Time From Injury

Background: Many factors can affect clinical outcomes and complications after a complex multiligament knee injury (MLKI). Certain aspects of the treatment algorithm for MLKI, such as the timing of surgery, remain controversial. Purpose: To determine the risk factors for common complications after MLKI reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted on 134 patients with MLKI who underwent reconstruction between 2011 and 2018 at a single academic center. Patients included in the review had a planned surgical reconstruction of >1 ligament based on clinical examination and magnetic resonance imaging. Complications were categorized as (1) wound infection requiring irrigation and debridement, (2) arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions, (3) deep venous thrombosis, (4) need for removal of hardware, and (5) revision ligament surgery. The potential risk factors for complications included patient characteristics, injury pattern categorized according to Schenck classification (knee dislocation [KD] I–KD IV), and timing of surgery. Significant risk factors for complications were analyzed by t test, chi-square test, and Fisher exact test. Results: A total of 108 patients met the inclusion criteria; of these, 29.6% experienced at least 1 complication. Smoking (odds ratio [OR], 3.20 [95% CI, 1.28-8.02]; P = .01) and planned staged surgery (OR, 2.71 [95% CI, 1.04-7.04]; P = .04) significantly increased the overall risk of complication, while increased time from injury to surgery (OR, 0.99 [95% CI, 0.98-0.998]; P < .01) significantly decreased the risk. Increasing time from injury to surgery (OR, 0.99 [95% CI, 0.97-0.998]; P = .02) also led to a slightly but significantly decreased risk for arthrofibrosis. Conclusion: The study findings suggest that smoking, decreased time from injury to initial surgery, and planned staged procedures may increase the rate of complications. Further studies are needed to determine which changes in the treatment algorithm are most effective to reduce the complication rate in patients.

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Always fighting and keeping hope: my experience of a complete quadriceps rupture and multiligament knee injury

British Journal of Sports Medicine ◽

10.1136/bjsports-2021-104137 ◽

2021 ◽

pp. bjsports-2021-104137

Author(s):

Johan Rodriguez

Keyword(s):

Knee Injury ◽

Multiligament Knee Injury

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Distal posterolateral corner injury in the setting of multiligament knee injury increases risk of common peroneal palsy

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06469-z ◽

2021 ◽

Author(s):

Anthony A. Essilfie ◽

Erin F. Alaia ◽

David A. Bloom ◽

Eoghan T. Hurley ◽

Michael Doran ◽

...

Keyword(s):

Knee Injury ◽

Posterolateral Corner ◽

Peroneal Palsy ◽

Multiligament Knee Injury ◽

Posterolateral Corner Injury

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Diagnosis and treatment of multiligament knee injury: state of the art

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2016-000072 ◽

2017 ◽

Vol 2 (3) ◽

pp. 152-161 ◽

Cited By ~ 25

Author(s):

Gilbert Moatshe ◽

Jorge Chahla ◽

Robert F LaPrade ◽

Lars Engebretsen

Keyword(s):

Knee Injury ◽

State Of The Art ◽

Diagnosis And Treatment ◽

Multiligament Knee Injury

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Result of single stage early surgical treatment of high-grade multiligamentous knee injuries (Schenck Type III, IV and V)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00519 ◽

2020 ◽

Vol 8 (9_suppl7) ◽

pp. 2325967120S0051

Author(s):

Arvind Prasad Gupta

Keyword(s):

Surgical Treatment ◽

Knee Injury ◽

Cruciate Ligament ◽

Weight Bearing ◽

Single Stage ◽

High Grade ◽

Collateral Ligament ◽

Multiligament Knee Injury ◽

Early Surgical Treatment

Introduction: The Multiligament Knee Injury is a complex knee problem and mostly associated with subluxation or dislocation of knee joint. Failure to diagnose and treat them appropriately can leads to devastating outcome particularly high-grade injury (Schenck Type 3,4 and 5). We favor single stage early surgical treatment of high grade Multiligament knee injury which leads to good functional outcome and return to work. Hypotheses: Single stage early surgical treatment of high grade Multiligament knee injury will leads to good functional outcome with higher IKDC and Lysholm score and helps the patients to in return early to work with higher satisfaction rate. Methods: From June 2013 to January 2020, 42 patients with age from 18 years to 56 years with acute (< 6 weeks) Multiligament knee injury included in surgical treatment. Patients with neurovascular injury were not included in study. From 42 patients, 28 patients was type 3,8 patients was type 4 and 6 patients was type 5 in this study. In all 42 patients, single stage treatment first Intraarticular ligament (anterior cruciate ligament ACL, posterior cruciate ligament PCL or both) reconstruction done by arthroscopic method then Extraarticular ligament (medial collateral ligament MCL, lateral collateral ligament LCL, Posterolateral corner PLC) treated with repair/augmentation/reconstruction depending upon status of ligaments by open method. We used only autograft (hamstring and peroneal longus tendon) of same limb or contralateral limb. Patient evaluation done with IKDC and Lyshlom score both in preoperative and postoperative period. Patient limb was kept in full extention in brace and started with aggressive physiotherapy with passive ROM at 2 weeks in post operative period . Follow up done at 2 weeks then every 6 weeks interval till 6 months then every 3 months interval. Partial weight bearing started at 6 weeks and full weight bearing usually between 10 weeks to 12 weeks. Results: Road traffic accident was the most common cause of Multiligament knee injury. Average follow up was 4 years (range 2 to 6.5 years) .40 % has excellent ,40% has good and 20% has average result. There was a significant improvement in both outcome scores as compared with the preoperative scores. Postoperatively average IKDC was 78 and Lyshlom was 86. Terminal restriction of knee movement was in 19% patients particularly those associated with medial side injury was the major complication in our study. Manipulation under anaesthesia was done in 4 cases and implant removal in 1 case and arthroscopic synovectomy and long term antibiotic in 1 case who develop early infection. Gade 1 posterior laxity and grade 1 varus stress was observed in 10 patints.Recovery after surgery takes 9 to 12 months of rehabilitation prior to returning to full activities. Conclusion: Proper evaluation and full diagnosis is key in Multiligament injury of knee. Failure to treat all injured structure can lead to change in knee kinematics and poorer outcome and increased risk for graft failure.Operative treatment with proper rehabilitation yields good functional and clinical outcome with early return to work and sports activity.

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