Hunter Collin D R, Featherall Joseph, McNamara Natalya, Greis Patrick, Maak Travis G, Aoki Stephen K, Klasan Antonio, Ernat Justin J
Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
AUVA UKH Steiermark, Department of Orthopedics and Traumatology, Graz, Austria.
Orthop J Sports Med. 2025 Jul 28;13(7):23259671251356696. doi: 10.1177/23259671251356696. eCollection 2025 Jul.
Multiligament knee injuries (MLKIs) are complex and challenging, with significant long-term consequences. While previous studies have examined chondral injuries in MLKI over time, there are limited data regarding their development during the interval between injury and surgery.
MLKIs with increased time interval between injury and surgery will be associated with an increased incidence of chondral injuries.
Case-control study; Level of evidence, 3.
This retrospective review utilized a multisurgeon database, including patients with MLKI treated from April 2008 to October 2022. Inclusion criteria were MLKI requiring surgical intervention, available operative reports, and documented date of injury in the electronic medical record. MLKIs were categorized by time interval from injury to surgery (acute, 0-90 days; delayed, 91-365 days; late, >365 days). The location and pattern of meniscal and chondral injuries were evaluated accordingly. Compartment injury patterns were also analyzed based on cruciate ligament injury pattern.
A total of 206 patients were included (acute, n = 138; delayed, n = 54; late, n = 14). The delayed and late groups had significantly higher mean numbers of chondral surface injury (out of 6 total surfaces evaluated) compared with the acute group (delayed, 1.79; late, 1.52; acute, 0.70; = .002). Trochlear cartilage injuries occurred significantly more frequently in the delayed (28%) compared with the acute group (9%; = .003). Similarly, patellar cartilage injuries were more common in the delayed (30%) compared with acute patients (12%; = .02). Medial femoral condylar chondral injuries were significantly increased in the delayed (30%) and late (50%) groups compared with acute (15%; = .002). Medial tibial plateau cartilage injuries followed the same pattern (acute, 13%; delayed, 30%; late, 43%; = .002). Patients with bicruciate MLKIs undergoing surgery after 90 days showed significantly higher trochlear (31% vs 8%; = .04) and patellar cartilage injury rates (35% vs 11%; = .03). ACL-based MLKIs operated beyond 90 days had increased rates of trochlear (22% vs 8%; = .03), medial femoral condylar (30% vs 13%; = .02), and medial tibial plateau (27% vs 11%; = .03) cartilage injury. PCL-based MLKI patients undergoing delayed surgery (>90 days) also had significantly higher medial femoral condylar (71% vs 8%; = .004) and medial tibial plateau (71% vs 8%; = .01) cartilage injury rates. Meniscal injury rates did not differ significantly across time groups.
Patients who underwent delayed surgery for their MLKI injuries had more medial and patellofemoral cartilage injuries at the time of surgery than those treated within 30 days of injury.
膝关节多韧带损伤（MLKIs）复杂且具有挑战性，会产生严重的长期后果。虽然此前的研究已对MLKI患者随时间推移出现的软骨损伤进行了检查，但关于损伤与手术间隔期内软骨损伤的发展情况，相关数据有限。
损伤与手术间隔时间延长的MLKIs患者，软骨损伤发生率会增加。
病例对照研究；证据等级：3级。
这项回顾性研究利用了一个多外科医生数据库，纳入了2008年4月至2022年10月接受治疗的MLKI患者。纳入标准为需要手术干预的MLKI、可用的手术报告以及电子病历中记录的受伤日期。MLKIs根据从受伤到手术的时间间隔进行分类（急性，0 - 90天；延迟，91 - 365天；晚期，>365天）。相应地评估半月板和软骨损伤的位置及类型。还根据交叉韧带损伤类型分析了关节损伤类型。
共纳入206例患者（急性组，n = 138；延迟组，n = 54；晚期组，n = 14）。与急性组相比，延迟组和晚期组的软骨表面损伤平均数量（在总共评估的6个表面中）显著更高（延迟组为1.79；晚期组为1.52；急性组为0.70；P = 0.002）。与急性组（9%）相比，延迟组（28%）滑车软骨损伤的发生频率显著更高（P = 0.003）。同样，与急性患者（12%）相比，延迟组（30%）髌软骨损伤更常见（P = 0.02）。与急性组（15%）相比，延迟组（30%）和晚期组（50%）股骨内侧髁软骨损伤显著增加（P = 0.002）。胫骨内侧平台软骨损伤也呈现相同模式（急性组为13%；延迟组为30%；晚期组为43%；P = 0.002）。90天后接受手术的双交叉韧带MLKIs患者，滑车软骨损伤率（31%对8%；P = 0.04）和髌软骨损伤率（35%对11%；P = 0.03）显著更高。90天后接受手术的基于前交叉韧带的MLKIs患者，滑车软骨损伤率（22%对8%；P = 0.03）、股骨内侧髁软骨损伤率（30%对13%；P = 0.02）和胫骨内侧平台软骨损伤率（27%对11%；P = 0.03）均有所增加。接受延迟手术（>90天）的基于后交叉韧带的MLKI患者，股骨内侧髁软骨损伤率（71%对8%；P = 0.004）和胫骨内侧平台软骨损伤率（71%对8%；P = 0.01）也显著更高。各时间组之间半月板损伤率无显著差异。
MLKI损伤接受延迟手术的患者，手术时内侧和髌股软骨损伤比受伤后30天内接受治疗的患者更多。
