Murray Iain Robert, Makaram Navnit S, Geeslin Andrew G, Chahla Jorge, Moatshe Gilbert, Crossley Kay, Kew Michelle E, Davis Aileen, Tuca Maria, Potter Hollis, Janse van Rensburg Dina C, Emery Carolyn A, Eun SeungPyo, Grindem Hege, Noyes Frank R, Marx Robert G, Harner Chris, Levy Bruce A, King Enda, Cook James L, Whelan Daniel B, Hatch George F, Wahl Christopher J, Thorborg Kristian, Irrgang James J, Pujol Nicolas, Medvecky Michael J, Stuart Michael J, Krych Aaron J, Engebretsen Lars, Stannard James P, MacDonald Peter, Seil Romain, Fanelli Gregory C, Maak Travis G, Shelbourne K Donald, Verhagen Evert, Musahl Volker, Hirschmann Michael T, Miller Mark D, Schenck Robert C, LaPrade Robert F
Edinburgh Orthopaedics, Edinburgh, UK.
University of Edinburgh, Edinburgh, UK.
Br J Sports Med. 2024 Dec 2;58(23):1385-1400. doi: 10.1136/bjsports-2024-108089.
Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined 'a priori' if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
膝关节多韧带损伤（MLKIs）涵盖了广泛的病理情况，可能产生毁灭性后果。目前，这些损伤在术语、诊断和治疗方面存在分歧，限制了临床护理和研究。本研究旨在就MLKI患者的命名、诊断、治疗和康复策略达成共识，同时确定进一步研究的重要优先事项。采用经过验证的德尔菲方法，按照指南进行了国际共识达成过程。一个由来自14个国家的39名成员组成的多学科小组完成了3轮在线调查，探讨了命名、诊断、治疗、康复和未来研究优先事项等方面。对每条陈述的一致程度（LoA）采用5点李克特量表进行匿名评分，鼓励专家提出修改意见或补充陈述。如果超过75%的受访者同意且少于10%的受访者不同意，则将最后一轮达成共识的LoA “先验”定义，记录并讨论不同意见。经过三轮德尔菲调查，50项（92.6%）达成了共识。在命名方面达成共识的关键陈述包括MLKI的明确定义（LoA 97.4%）以及需要一个更新的MLKI分类系统，该系统根据损伤机制、非韧带结构损伤程度以及是否存在脱位进行分类。在诊断方面，达成的共识是，在高能量情况下以及对于某些损伤模式，包括双交叉韧带和后外侧角损伤，对MLKI进行CT血管造影评估的阈值应较低（LoA 89.7%）。应力放射照相或术中透视的价值也达成了共识（LoA 89.7%）。在治疗方面，普遍认为现有文献总体上倾向于对MLKI进行手术治疗，特别是对于年轻患者（LoA 100%），并且应尽可能进行一期手术（LoA 92.3%）。这一共识声明将促进MLKI的临床沟通、这些患者的护理以及MLKI的未来研究。
