Klasan Antonio, Maerz Anne, Putnis Sven E, Ernat Justin J, Ollier Edouard, Neri Thomas
AUVA UKH Steiermark, Graz, Austria.
Johannes Kepler University Linz, Linz, Austria.
Knee Surg Sports Traumatol Arthrosc. 2025 Apr;33(4):1281-1298. doi: 10.1002/ksa.12442. Epub 2024 Aug 28.
Multiligament knee injuries (MLKIs) are devastating injuries that can have life-long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow-up.
Four databases were queried for surgical outcome-based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2-year follow-up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow-up period, anatomical region and posterior-cruciate ligament (PCL)-based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random-effects model analysis was performed.
After the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow-up was 4.06 years (range 2-12.7). The mean Lysholm score at 2-year follow-up was 86.09 [95% confidence interval [CI]: 82.90-89.28], with a yearly decrease of -0.80 [95% CI: -1.47 -0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56-86.14], with a yearly decrease of -1.99 [95% CI: -3.14 -0.84] (p < 0.001). Non-PCL-based injuries had a higher IKDC 83.69 [75.55-91.82] vs. 75.00 [70.75-79.26] (p = 0.03) and Lysholm score 90.84 [87.10-94.58] versus 84.35 [82.18-86.52] (p < 0.01) than PCL-based injuries, respectively.
According to the present systematic review and meta-analysis of MLKIs with minimum 2-year follow-ups, the patients who suffered an MLKI can expect to retain around 80-85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL-based injuries at 2 years postoperative.
Level IV meta-analysis.
多韧带膝关节损伤（MLKIs）是严重的损伤，可产生终身影响。治疗方案需要决定是否进行手术、手术时机、修复与重建的考量、重建技术以及重建移植物的选择。本研究的目的是分析至少随访2年的MLKIs临床结果随时间的变化情况。
查询了四个数据库，以获取2000年1月至2022年9月发表的关于MLKIs基于手术结果的研究，且随访时间至少为2年。排除技术文章、非手术治疗、关节成形术、儿科和综述文章。收集研究特征，包括设计、患者数量、年龄、随访期、解剖区域和基于后交叉韧带（PCL）的损伤情况。主要结局指标为Lysholm评分、国际膝关节文献委员会（IKDC）结局评分和Tegner活动评分。进行随机效应模型分析。
应用纳入和排除标准后，79项研究中的3571例患者纳入分析。手术时的平均年龄为35.6岁。平均随访时间为4.06年（范围2 - 12.7年）。2年随访时的平均Lysholm评分为86.09[95%置信区间（CI）：82.90 - 89.28]，每年下降-0.80[95%CI：-1.47 - 0.13]，（p = 0.0199）。2年时的平均IKDC评分为81.35[95%CI：76.56 - 86.14]，每年下降-1.99[95%CI：-3.14 - 0.84]（p < 0.001）。非基于PCL的损伤在IKDC评分上更高，分别为83.69[75.55 - 91.82]对比75.00[70.75 - 79.26]（p = 0.03），在Lysholm评分上为90.84[87.10 - 94.58]对比84.35[82.18 - 86.52]（p < 0.01）。
根据目前对至少随访2年的MLKIs进行的系统评价和荟萃分析，MLKIs患者在2年时可预期保留约80 - 85%的膝关节功能，且根据所使用的评分，膝关节功能预计每年会恶化。术后2年时，基于PCL的损伤预期结果较差。
IV级荟萃分析。
