Sim Jae Ang, Lee Sang-Jin, Shin Jung-Min, Lee Byung Hoon
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, 21936, Republic of Korea.
Department of Rheumatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea.
Eur J Trauma Emerg Surg. 2025 Apr 7;51(1):163. doi: 10.1007/s00068-024-02740-3.
This study aimed to compare the incidence rates of concomitant injuries, including meniscal and cartilage injuries, between multiligamentous knee injuries (MLKI) with and without dislocation based on our 15-year experience of knee dislocation and MLKI at a level 1 trauma center.
We retrospectively identified 100 patients (115 knees) with MLKIs and/or dislocations at our trauma center between 2007 and 2021. Magnetic resonance imaging was routinely performed to evaluate the injured structures and extent of injury. The anatomic structures of the knee were categorized into anterior and posterior cruciate ligaments (ACL, PCL) and medial and posterolateral structures, and further classified according to the modified Schenck classification. The study participants were divided into two groups: 40 and 75 knees classified as MLKI with and without dislocation, respectively.
MLKIs with dislocations showed 13% (5/40 knees) and 18% (7/40 knees) incidence, whereas MLKIs without dislocation showed 15% (11/75 knees) and 13% (10/75 knees) incidence of medial and lateral meniscal tears respectively. The two groups also had a significant discrepancy in the patterns of meniscal tears. For medial meniscal tears, radial tears were more prevalent in MLKIs with dislocation, and longitudinal tears in MLKIs without dislocation (p = 0.197). For lateral meniscal tears, anterior horn or totally detached tears were more prevalent in MLKIs with dislocation, and radial tears in MLKIs without dislocation (p = 0.026). Additionally, complete rupture of all four major ligaments was found in 38% (15/40 knees) of the cases with dislocation, with the majority showing complete ruptures of both the ACL and PCL. Concomitant serious injuries, such as popliteal artery injury and fractures, were observed only in cases involving high-energy trauma and dislocation.
MLKIs with dislocation show distinct ligament and meniscal injury patterns compared to those without, highlighting the importance of severity and anatomical classification in diagnosing associated knee injuries.
The initial distinction in the severity of MLKIs, along with the anatomical classification, have practical implications in identifying associated meniscal tears and injuries to structures surrounding the knee joint.
IV Retrospective comparative study.
基于我们在一级创伤中心对膝关节脱位和多韧带膝关节损伤（MLKI）的15年经验，本研究旨在比较伴有和不伴有脱位的多韧带膝关节损伤（MLKI）中半月板和软骨损伤等伴随损伤的发生率。
我们回顾性确定了2007年至2021年间在我们创伤中心发生MLKI和/或脱位的100例患者（115个膝关节）。常规进行磁共振成像以评估损伤结构和损伤程度。膝关节的解剖结构分为前交叉韧带和后交叉韧带（ACL、PCL）以及内侧和后外侧结构，并根据改良的申克分类法进一步分类。研究参与者分为两组：分别有40个和75个膝关节被分类为伴有和不伴有脱位的MLKI。
伴有脱位的MLKI中，内侧和外侧半月板撕裂的发生率分别为13%（5/40个膝关节）和18%（7/40个膝关节），而不伴有脱位的MLKI中，内侧和外侧半月板撕裂的发生率分别为15%（11/75个膝关节）和13%（10/75个膝关节）。两组在半月板撕裂模式上也存在显著差异。对于内侧半月板撕裂，放射状撕裂在伴有脱位的MLKI中更常见，而纵向撕裂在不伴有脱位的MLKI中更常见（p = 0.197）。对于外侧半月板撕裂，前角或完全分离的撕裂在伴有脱位的MLKI中更常见，而放射状撕裂在不伴有脱位的MLKI中更常见（p = 0.026）。此外，在38%（15/40个膝关节）的脱位病例中发现所有四条主要韧带完全断裂，大多数病例显示ACL和PCL均完全断裂。仅在涉及高能量创伤和脱位的病例中观察到伴随的严重损伤，如腘动脉损伤和骨折。
与不伴有脱位的MLKI相比，伴有脱位的MLKI表现出不同的韧带和半月板损伤模式，突出了严重程度和解剖学分类在诊断相关膝关节损伤中的重要性。
MLKI严重程度的初步区分以及解剖学分类，在识别相关半月板撕裂和膝关节周围结构损伤方面具有实际意义。
IV级回顾性比较研究。
