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Multiple-Ligament Knee Injuries in the United States Military Active-Duty Population

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The Multiple Ligament Injured Knee

Abstract

The multiple-ligament injured knee is a devastating orthopedic injury that can result in long-term disability. Although the incidence within the military population has not been established, there are several reports describing the pathology and prognosis associated with these injuries in service members. The mechanisms are typically high-energy trauma, sports or training injury, or combat-related. The principles of management of multiple-ligamentous knee injuries in the active-duty service member are similar to that in civilian trauma. However, combat-related multiple-ligament knee injuries have unique treatment considerations due to austere settings and combat mechanisms that result in complex extremity trauma and amputation. The goal for a soldier with a multiple-ligament knee injury is surgical reconstruction to restore stability and function to the extremity and to allow return to duty. As in civilian trauma, the challenge with multiple-ligament knee injuries is that treatment is dictated by the specific ligaments injured, the severity and constellation of associated injuries, and the performance requirements or expectations of the patient.

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Abbreviations

ABI:

Ankle–brachial index

ACL:

Anterior cruciate ligament

ATLS:

Advanced trauma life support

CT:

Computerized tomography

DNBI:

Disease and non-battle injuries

IED:

Improvised explosive devices

LCL:

Lateral collateral ligament

MCL:

Medical collateral ligament

MOS:

Military occupational specialty

MRI:

Magnetic resonance imaging

OEF:

Operation enduring freedom

OIF:

Operation Iraqi freedom

PCL:

Posterior cruciate ligament

PEB:

Physical Evaluation Board

PLC:

Posterior lateral corner

TCCC:

Tactical combat casualty care

US:

United States

USAF:

United States Air Force

References

  1. Cameron KL, Owens BD. Musculoskeletal injuries in the military. 1st ed. New York: Springer; 2016.

    Book  Google Scholar 

  2. Lauder TD, Baker SP, Smith GS, Lincoln AE. Sports and physical training injury hospitalizations in the army. Am J Prev Med. 2000;18(3 Suppl):118–28.

    Article  CAS  Google Scholar 

  3. Hill OT, Kay AB, Wahi MM, McKinnon CJ, Bulathsinhala L, Haley TF. Rates of knee injury in the U.S. Active Duty Army, 2000–2005. Mil Med. 2012;177(7):840–4.

    Article  Google Scholar 

  4. Gage BE, McIlvain NM, Collins CL, Fields SK, Comstock RD. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 2012;19(4):378–85.

    Article  Google Scholar 

  5. Owens BD, Belmont PJ. Combat orthopedic surgery: lessons learned in Iraq and Afghanistan. 1st ed. Thorofare, NJ: Slack Incorporated; 2011.

    Google Scholar 

  6. Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC. Characterization of extremity wounds in operation Iraqi freedom and operation enduring freedom. J Orthop Trauma. 2007;21(4):254–7.

    Article  Google Scholar 

  7. Owens BD, Neault M, Benson E, Busconi BD. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma. 2007;21(2):92–6.

    Article  Google Scholar 

  8. Barrow AE, Sheean AJ, Burns TC. Return to duty following combat-related multi-ligamentous knee injury. Injury. 2017;48(4):861–5.

    Article  Google Scholar 

  9. Belmont PJ Jr, Thomas D, Goodman GP, Schoenfeld AJ, Zacchilli M, Burks R, et al. Combat musculoskeletal wounds in a US Army brigade combat team during operation Iraqi freedom. The J Trauma. 2011;71(1):E1–7.

    Article  Google Scholar 

  10. Kilcoyne K, Dickens J, Kroski W, Waterman S, Davila J. Ligamentous knee injuries in amputees. J Surg Orthop Adv. 2012;21(1):44–9.

    PubMed  Google Scholar 

  11. Lee W, Kim HS, Kim SJ, Kim HH, Chung JW, Kang HS, et al. CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint. Korean J Radiol. 2004;5(1):47–54.

    Article  Google Scholar 

  12. Lenhart MK, Savitsky E, Eastridge B. Combat casualty care: lessons learned from OEF and OIF. Falls Church, VA: Office of the Surgeon General, Department of the Army; 2012.

    Google Scholar 

  13. Martin MJ, Beekley AC. Front line surgery: a practical approach. 2nd ed. New York, NY: Springer International Publishing; 2017.

    Book  Google Scholar 

  14. Khakha RS, Day AC, Gibbs J, Allen S, Hill P, Hull J, et al. Acute surgical management of traumatic knee dislocations–average follow-up of 10 years. Knee. 2016;23(2):267–75.

    Article  CAS  Google Scholar 

  15. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthrosc: J Arthrosc Relat surg. 2009;25(4):430–8.

    Article  Google Scholar 

  16. Darabos N, Gusic N, Vlahovic T, Darabos A, Popovic I, Vlahovic I. Staged management of knee dislocation in polytrauma injured patients. Injury. 2013;44(Suppl 3):S40–5.

    Article  Google Scholar 

  17. Barber FA, Cowden CH 3rd, Sanders EJ. Revision rates after anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft or autograft in a population 25 years old and younger. Arthrosc: J Arthrosc Relat Surg. 2014;30(4):483–91.

    Article  Google Scholar 

  18. Maletis GB, Chen J, Inacio MCS, Love RM, Funahashi TT. Increased risk of revision after anterior cruciate ligament reconstruction with soft tissue allografts compared with autografts: graft processing and time make a difference. Am J Sports Med. 2017;45(8):1837–44.

    Article  Google Scholar 

  19. Lynch AD, Chmielewski T, Bailey L, Stuart M, Cooper J, Coady C, et al. Current concepts and controversies in rehabilitation after surgery for multiple ligament knee injury. Curr Rev Musculoskelet Med. 2017;10(3):328–45.

    Article  Google Scholar 

  20. Ross AE, Taylor KF, Kirk KL, Murphy KP. Functional outcome of multiligamentous knee injuries treated arthroscopically in active duty soldiers. Mil Med. 2009;174(10):1113–7.

    Article  Google Scholar 

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Correspondence to Mark P. Pallis .

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Pallis, M.P., Lanzi, J.T., Garcia, E.J., Weiss, W.M., Chan, A.G. (2019). Multiple-Ligament Knee Injuries in the United States Military Active-Duty Population. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-05396-3_34

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  • DOI: https://doi.org/10.1007/978-3-030-05396-3_34

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-05395-6

  • Online ISBN: 978-3-030-05396-3

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