Multiple Ligament Knee Injuries: Does the Knee Dislocation Classification Predict the Type of Surgical Management?

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Trauma Surgery

Background:

• Multiple ligament knee injuries (MLKI) are complex and often require surgical intervention.
• Current classification systems, such as the knee dislocation (KD) classification, aim to standardize injury assessment.
• Predicting the optimal surgical management strategy for MLKIs remains a challenge.

Purpose of the Study:

• To evaluate the relationship between MLKI patterns, classified by the KD system, and surgical management choices.
• To determine if additional injury features (structure, chronicity, grade, location) are more predictive of surgical management than the KD classification alone.

Main Methods:

• Retrospective cohort study of 287 patients with MLKIs treated operatively at a Level I trauma center (2011-2015).
• Billing databases were queried using ICD-9, ICD-10, and CPT codes to identify patient cohorts.
• Injuries were analyzed based on the KD classification and recategorized by structure, chronicity, grade, and topographic location.

Main Results:

• The KD classification alone was not predictive of surgery timing, staging, or intervention type (p > 0.05).
• Recategorization revealed that partial non-ACL injuries were more often repaired primarily (p < 0.001).
• Distal medial-sided injuries had higher odds of operative treatment (OR = 24.7, p < 0.0001), and staging was more frequent for combined PCL-lateral injuries and nonavulsive fractures.

Conclusions:

• The KD classification is insufficient for predicting surgical management strategies in MLKIs.
• Incorporating injury grade and topographic location into classification systems enhances predictability of surgical intervention for MLKIs.
• A more detailed injury characterization is crucial for guiding surgical decision-making in complex knee injuries.