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Poly-traumatic multi-ligament knee injuries: is the knee the limiting factor?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Multi-ligament knee injuries (MLKI) from a high-velocity accident are rare but potentially devastating. This matched cohort analysis compares knee functional outcomes after multiple ligament reconstruction in poly-trauma patients to those that occurred in isolation.

Methods

Sixty-two patients with MLKI that occurred either as a component of polytrauma or had occurred in isolation were matched according to age, sex, and knee dislocation grade. Functional outcomes and knee physical examination were assessed at a 2-year follow-up. New Injury Severity Score (NISS) was calculated based on the poly-traumatic injury pattern. Risk factors for worse outcomes in the poly-trauma cohort were analyzed.

Results

The mean IKDC, Lysholm, and NISS scores in the polytrauma cohort were 57.2 ± 21.9, 62 ± 22, and 40.9 ± 20.4, respectively, at a mean of 67 months (range 24–220). The isolated knee injury group was followed for a mean of 74 months (range 24–266) with mean IKDC and Lysholm scores of 71.1 ± 26.5 and 78 ± 23, respectively. Patients in the control cohort had significantly higher IKDC (p = 0.01) and Lysholm scores, (p = 0.003). There were no major differences between the two groups in regards physical examination findings at final follow-up. None of the analyzed risk factors was predictive of poor outcome.

Conclusion

When comparing knees with similar multi-ligament and neurovascular injury patterns, patients who sustained their injury as a result of poly-trauma demonstrated significantly lower functional scores following reconstruction. This is despite restoration of similar knee stability and range of motion. The functional outcomes following MLKI reconstruction in poly-traumatized patients are influenced by factors other than the knee including concomitant injuries and psychosocial factors.

Level of evidence

Therapeutic Level III.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Jarret M. Woodmass, Nick R. Johnson, Rohith Mohan, Aaron J. Krych, Bruce A. Levy & Michael J. Stuart

Authors
  1. Jarret M. Woodmass
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  2. Nick R. Johnson
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  3. Rohith Mohan
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  4. Aaron J. Krych
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  5. Bruce A. Levy
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  6. Michael J. Stuart
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Corresponding author

Correspondence to Bruce A. Levy.

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Conflict of interest

No outside financial support was utilized for this study. Other potential conflicts of interest include: AJK is a consultant for Vericel and receives research support from Aesculap/B.Braun, Arthritis Foundation, Ceterix, and Histogenics. BAL is a consultant for Smith & Nephew and receives research support from Arthrex, Biomet, Smith & Nephew, and Stryker. MJS receives research support from Stryker. AJK, BAL, and MJS are consultants for and receive intellectual property royalties from Arthrex.

Funding

No external funding sources were used for this study.

Ethical approval

Ethical approval was obtained from the Institutional Review Board of the Mayo Clinic.

Informed consent

Informed consent was obtained from all individuals who participated in the study.

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Woodmass, J.M., Johnson, N.R., Mohan, R. et al. Poly-traumatic multi-ligament knee injuries: is the knee the limiting factor?. Knee Surg Sports Traumatol Arthrosc 26, 2865–2871 (2018). https://doi.org/10.1007/s00167-017-4784-3

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  • DOI: https://doi.org/10.1007/s00167-017-4784-3

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