Description
Objectives: The multiple ligament injured knee (knee dislocation) is oftentimes part of a multisystem injury complex that can include injuries not only to knee ligaments but also to blood vessels, skin, nerves, bones (fractures), head, and other organ system trauma. We aimed to evaluate our own 15-year experience of knee dislocation and multiligamentous knee injury (MLKI) as Korea major trauma centre, and to characterize multiligamentous knee injury patterns and describe associated morbidities.
Methods: We retrospectively identified one hundred patients (115 knees) with multiligamentous knee injuries and/or dislocations from 2007 through 2021 who were treated at our trauma center. MLKIs have been classified by position, energy of the injury, injury causes, the injured anatomic structures. Magnetic resonance imaging (MRI) was routinely obtained once the patient’s overall condition allows, by which injured structures as well as the degree of injury were evaluated . The anatomic structures of the knee were separated into 4 groups: the ACL, PCL, medial structures, and posterolateral structures. And all knees were classified according to Schenck classification.
Results: 115 multiligamentous knee injuries during the nearly 15-year period that was evaluated met the inclusion criteria. The right knee was affected in 54 (54%) of the 100 patients, the left knee was affected in 31 (31%), and bilateral knee injuries occurred in 16 (16%) of the 100 patients. Eighty-four (84%) patients were male, and 16 (16%) were female. The average age of the patients was 48 ± 16 years(range,15-92 years). Most common injury mechanism was pedestrian TA, then motorcycle collision. The incidences of ligamentous injury based on MRI findings were as follows: anterior cruciate ligament, 67% (77 of 115 extremities with appropriate MRI findings available); posterior cruciate ligament, 67% (77 extremities); posterolateral corner, 44% (51 extremities); and medial collateral ligament, 52% (60 extremities). 22% of knees had associated ipsilateral tibial plateau fractures, and 8% had associated ipsilateral patellar fractures, 6% of distal femur, and 5% of tibial shaft fracture. Popliteal arterial injury was present in in 3 cases (3%).
Conclusions: More than half the multiligamentous knee injuries involved the anterior cruciate ligament and posterior cruciate ligament. The incidence of peroneal artery injury was comparable to previous reports. Initial evaluation of MLKIs with the anatomic classification having the most practical application of concomitant meniscal tears and cartilage injuries
