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Published on: October 20, 2023
High-Energy and Polytraumatic Multiligament Knee Injuries Requiring Surgical Treatment Are Associated With More
Collin D R Hunter1, Joseph Featherall2, Natalya McNamara2
1School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A.
Purpose:
To compare the rates of meniscal and chondral injuries that occur with high-energy (HE) versus low-energy (LE) and polytraumatic (PT) versus non-polytraumatic (NPT) multiligament knee injury (MLKI) mechanisms.
Methods:
This single-institution retrospective review included patients with MLKIs treated from April 2008 to August 2024. The inclusion criteria were surgically treated MLKIs, available operative reports, and inclusion of mechanism of injury (PT vs NPT and HE vs LE) in the electronic medical record. The location and grading of chondral injuries and size of meniscal injuries were evaluated accordingly. Additionally, a subanalysis considered anterior and posterior cruciate ligament injury patterns.
Results:
A total of 206 patients with MLKIs were included (57 PT [28%] and 149 NPT [72%]; 84 HE [41%] and 122 LE [59%]). The chondral injury incidence was greater in PT patients (53%) and HE patients (45%) compared with NPT patients (27%, P = .004) and LE patients (26%, P = .001), respectively. The mean number of surfaces injured was higher in PT patients versus NPT patients (1.59 ± 1.94 vs 0.77 ± 1.58, P = .002) and HE patients versus LE patients (1.48 ± 1.99 vs 0.66 ± 1.43, P < .001). PT patients exhibited more chondral injuries of the medial femoral condyle (39% vs 15%, P < .001), lateral femoral condyle (21% vs 10%, P = .034), and medial tibial plateau (33% vs 14%, P = .001) compared with NPT patients. HE patients exhibited more chondral injuries of the medial femoral condyle (20% vs 8%, P < .001), lateral femoral condyle (19% vs 9%, P = .035), and medial tibial plateau (32% vs 11%, P < .001) than LE patients. No differences were found in rates of meniscal tears or chondral injuries of the lateral tibial plateau or patellofemoral joint. Cruciate ligament injury pattern did not impact rates of any injuries.
Conclusions:
MLKIs from HE and PT mechanisms requiring definitive surgical treatment were associated with higher rates of chondral injury across more surfaces compared with MLKIs from NPT and LE mechanisms, respectively. The mechanism by which the injury occurs does not appear to impact the rate of meniscal tears, nor does cruciate ligament injury pattern matter.
Level Of Evidence:
Level III, retrospective comparative case series.
