Daniel Adam V, Johnson Taylor A, Druskovich Katherine F, Williams Warren A, Miller Daniel, Kupiszewski Stanley J
Orlando Health Jewett Orthopedic Institute, Orlando, Florida, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Dec 15;7(2):101070. doi: 10.1016/j.asmr.2024.101070. eCollection 2025 Apr.
To examine outcomes after surgical treatment of multiligamentous knee injuries (MLKIs) in patients with dislocated versus non-dislocated knees.
Patients who were surgically treated for MLKIs between 2008 and 2021 were included in this study. Patients were divided into 2 groups: those with a frank knee dislocation (KD), diagnosed by radiographs or reduction notes in the emergency department, and those without a frank KD (non-KD). The following patient-reported outcome measures were collected: visual analog scale for pain, International Knee Documentation Committee subjective score, and Lysholm knee scoring scale. Additional procedures such as revision ligamentous reconstruction and complications such as infection and arthrofibrosis were also obtained.
A total of 88 patients (88 knees; 36 KD vs 52 non-KD) were included in the final analysis. This study included 30 female and 58 male patients, and the mean age was 34.3 ± 12.7 years (range, 10-61 years). The mean follow-up period for the patients who did not receive revision surgery was 9.2 years (range, 3.4-15.3 years). There were no differences in age, sex, mechanism of injury, meniscal/chondral injury, or neurovascular status between the groups. Furthermore, there were no differences in visual analog scale, International Knee Documentation Committee, or Lysholm scores. Significantly more patients in the KD group showed higher KD grades (KD III-KD V, 29 [81%] vs 21 [40%]; < .001), and significantly more KD I injuries were observed in the non-KD group (48.1% vs 11.1%, < .001). More patients in the KD group underwent staged procedures (69.4% vs 28.8%, < .001) and had external fixators applied (50% vs 5.8%, < .001). The overall complication rate was comparable between groups, with no differences in revision surgery or arthrofibrosis; however, the KD group had a higher postoperative infection rate (16.7% vs 1.9%, = .017).
Patients who experienced frank KDs showed an increased odds of receiving external fixation, showed an increased odds of undergoing a staged procedure, had higher grades of injury, and had a higher risk of postoperative infection compared with those without KDs. At final follow-up, no differences in patient-reported outcomes were noted between the 2 groups.
Level III, retrospective cohort study.
探讨膝关节脱位与未脱位患者多韧带膝关节损伤（MLKIs）手术治疗后的结果。
本研究纳入2008年至2021年期间接受MLKIs手术治疗的患者。患者分为两组：经X线片或急诊科复位记录诊断为明显膝关节脱位（KD）的患者，以及无明显KD的患者（非KD）。收集以下患者报告的结局指标：疼痛视觉模拟量表、国际膝关节文献委员会主观评分和Lysholm膝关节评分量表。还获取了诸如翻修韧带重建等额外手术以及感染和关节纤维化等并发症的情况。
最终分析共纳入88例患者（88膝；36例KD vs 52例非KD）。本研究包括30例女性和58例男性患者，平均年龄为34.3±12.7岁（范围10 - 61岁）。未接受翻修手术患者的平均随访期为9.2年（范围3.4 - 15.3年）。两组在年龄、性别、损伤机制、半月板/软骨损伤或神经血管状况方面无差异。此外，在视觉模拟量表、国际膝关节文献委员会评分或Lysholm评分方面也无差异。KD组中明显更多患者表现为更高的KD分级（KD III - KD V，29例[81%] vs 21例[40%]；P <.001），且非KD组中观察到明显更多的KD I损伤（48.1% vs 11.1%，P <.001）。KD组中更多患者接受了分期手术（69.4% vs 28.8%，P <.001）并应用了外固定器（50% vs 5.8%，P <.001）。两组总体并发症发生率相当，在翻修手术或关节纤维化方面无差异；然而，KD组术后感染率更高（16.7% vs 1.9%，P =.017）。
与未发生KD的患者相比，发生明显KD的患者接受外固定的几率增加，接受分期手术的几率增加，损伤分级更高，术后感染风险更高。在最终随访时，两组患者报告的结局无差异。
III级，回顾性队列研究。
