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Knee Joint

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Investigating the Ligament Involvement in High-Energy and Polytraumatic Multiligament Knee Injuries Compared With

Collin D R Hunter¹, Joseph Featherall¹, Natalya McNamara¹

¹Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.

Orthopaedic Journal of Sports Medicine

|February 14, 2025

Summary

High-energy (HE) and polytraumatic (PT) multiligament knee injuries (MLKIs) involve more ligament damage, particularly to the posterior cruciate ligament (PCL) and lateral collateral ligament (LCL). These severe injuries often require LCL reconstruction or repair.

Keywords:

PCL knee knee ligaments lateral/posterior knee ligaments multiligament injuries

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Area of Science:

Orthopedic Surgery
Sports Medicine
Trauma Surgery

Background:

Multiligament knee injuries (MLKIs) from high-energy (HE) or polytraumatic (PT) mechanisms are associated with poorer surgical outcomes compared to low-energy (LE) or nonpolytraumatic (NPT) injuries.
Limited research exists on the specific characteristics of MLKIs resulting from HE or PT mechanisms.

Purpose of the Study:

To compare ligamentous injury and surgical patterns in MLKIs between high-energy (HE) versus low-energy (LE) mechanisms.
To compare ligamentous injury and surgical patterns in MLKIs between polytraumatic (PT) versus nonpolytraumatic (NPT) classifications.

Main Methods:

Retrospective chart review of 176 patients undergoing surgical MLKI treatment.
Patients were stratified by injury mechanism: HE vs. LE and PT vs. NPT.
Data collected included demographics, clinical/radiographic findings, and intraoperative variables.

Main Results:

Polytraumatic (PT) and high-energy (HE) MLKIs showed significantly higher rates of posterior cruciate ligament (PCL) and lateral collateral ligament (LCL) injuries compared to nonpolytraumatic (NPT) and low-energy (LE) groups.
PT and HE groups sustained a higher average number of injured ligaments (2.9 and 2.8, respectively) versus NPT and LE groups (2.4 each).
LCL surgical interventions (reconstruction/repair) were more frequent in PT (55%) and HE (53%) patients compared to NPT (36%) and LE (34%) patients.

Conclusions:

High-energy (HE) and polytraumatic (PT) multiligament knee injuries (MLKIs) are distinct, featuring increased PCL and LCL involvement.
These severe injury patterns necessitate more frequent LCL surgical repair or reconstruction.
Injury severity and mechanism are crucial factors that may guide clinical decision-making for MLKIs.