Scheepers Waldo, Khanduja Vikas, Held Michael
Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, 7925 Cape Town, South Africa.
Consultant Orthopedic Surgeon, Addenbrooke's - Cambridge University Hospital, Cambridge CB2 0QQ, United Kingdom.
SICOT J. 2021;7:62. doi: 10.1051/sicotj/2021058. Epub 2021 Dec 6.
Multiligament knee injuries (MLKIs), though rare, pose significant challenges to the patient and surgeon. They often occur in the setting of high-velocity trauma and are frequently associated with concomitant intra- and extra-articular injuries, the most immediately devastating of which is vascular compromise. A detailed evaluation is required when acute or chronic MLKIs are suspected, and stress radiography, MRI and angiography are valuable adjuncts to a thorough clinical examination. Surgical treatment is widely regarded as superior to non-surgical management and has been demonstrated to improve functional outcome scores, return to work, and return to sport rates, though the incidence of post-traumatic osteoarthritis remains high in affected knees. However, acceptable results have been obtained with conservative management in populations where surgical intervention is not feasible. Early arthroscopic single-stage reconstruction is currently the mainstay of treatment for these injuries, but some recent comparative studies have found no significant differences in outcomes. Recent trends in the literature on MLKIs seem to favour early surgery over delayed surgery, though both methods have distinct advantages and disadvantages. Due to the heterogeneity of the injury and the diversity of patient factors, treatment needs to be individualised, and a single best approach with regards to the timing of surgery, repair versus reconstruction, surgical technique and surgical principles cannot be advocated. There is much controversy in the literature surrounding these topics. Early post-operative rehabilitation remains one of the most important positive prognostic factors in surgical management and requires a dedicated team-based approach. Though outcomes of MLKIs are generally favourable, complications are abundant and precautionary measures should be implemented where possible. Low resource settings are faced with unique challenges, necessitating adaptability and pragmatism in tailoring a management strategy capable of achieving comparable outcomes.
多韧带膝关节损伤（MLKIs）虽然罕见，但给患者和外科医生带来了重大挑战。它们常发生在高速创伤的情况下，并且经常伴有关节内和关节外的合并损伤，其中最直接具有毁灭性的是血管损伤。当怀疑有急性或慢性MLKIs时，需要进行详细评估，应力放射照相、磁共振成像（MRI）和血管造影是全面临床检查的重要辅助手段。手术治疗被广泛认为优于非手术治疗，并且已证明可以提高功能结果评分、恢复工作和恢复运动的比例，尽管受影响膝关节创伤后骨关节炎的发生率仍然很高。然而，在无法进行手术干预的人群中，保守治疗也取得了可接受的结果。早期关节镜单阶段重建目前是这些损伤治疗的主要方法，但最近的一些比较研究发现结果没有显著差异。关于MLKIs的文献最新趋势似乎倾向于早期手术而非延迟手术，不过两种方法都有明显的优缺点。由于损伤的异质性和患者因素的多样性，治疗需要个体化，不能提倡关于手术时机、修复与重建、手术技术和手术原则的单一最佳方法。围绕这些主题的文献存在很多争议。术后早期康复仍然是手术治疗中最重要的积极预后因素之一，需要一种专门的团队协作方法。虽然MLKIs的结果总体上是有利的，但并发症很多，应尽可能采取预防措施。资源匮乏地区面临独特的挑战，因此在制定能够取得可比结果的管理策略时需要适应性和务实性。
