Abstract
This 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.
Keywords
knee ligament - sports medicine - knee trauma
