Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
Ironman Sports Medicine Institute, Memorial Hermann Medical System, Houston, Texas.
J Knee Surg. 2021 Feb;34(3):273-279. doi: 10.1055/s-0039-1695739. Epub 2020 Mar 17.
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/m (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 ( > 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 ( < 0.001), distal medial-sided injuries were more frequently treated operatively than proximal medial-sided injuries (odds ratio [OR] = 24.7; <0.0001), and staging was more frequent for combined PCL-lateral injuries (OR = 1.3; = 0.003) and nonavulsive fractures (OR = 1.2; = 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.
本研究旨在评估根据膝关节脱位（KD）分类和所采用的手术治疗类型对多发韧带膝关节损伤（MLKI）模式的关系。我们假设 KD 分类不能预测手术治疗类型，而根据结构、慢性程度、等级和解剖位置等其他损伤特征对损伤进行分类将有助于预测手术治疗类型。这是一项回顾性队列研究。该研究在一个有 150 英里覆盖半径的一级创伤中心进行。通过使用 43 个计费代码（国际疾病分类[ICD]9、ICD-10 和当前程序术语）的组合对我们的计费数据库进行查询，以确定 2011 年至 2015 年间接受 MLKI 手术治疗的患者。对于个别韧带损伤，有手术或非手术治疗、个别韧带损伤的修复或重建，以及每个手术程序的分期或非分期。主要结果是特定韧带损伤模式的临床管理的性质和时间。共有 287 名患者纳入本研究，其中男性 199 名（69.3%），平均年龄 30.2 岁（标准差[SD]：14.0），平均 BMI 为 28.8kg/m（SD：7.4）。212 处损伤（73.9%）分为 KD-I 或 KD-V 型。KD 分类本身并不能预测手术时机、分期或任何受伤韧带的任何干预措施（ > 0.05）。根据结构、慢性程度、等级和位置对损伤模式进行重新分类，结果如下：部分非前交叉韧带损伤更常被直接修复（ < 0.001），远端内侧损伤比近端内侧损伤更常接受手术治疗（比值比[OR] = 24.7； <0.0001），分期更常见于后交叉韧带-外侧复合体损伤（OR = 1.3； = 0.003）和非撕脱性骨折（OR = 1.2； = 0.0009）。KD 分类本身不能预测任何手术治疗策略。当指定每个韧带损伤的等级和解剖位置时，手术治疗是可以预测的。这是一项 IV 级回顾性队列研究。
