High-Energy and Polytraumatic Multiligament Knee Injuries Requiring Surgical Treatment Are Associated with More Chondral Damage Yet Similar Rates of Meniscal Injury.
Collin D R Hunter, Joseph Featherall, Natalya McNamara, Benjamin T Johnson, Pat Greis, Travis G Maak, Stephen K Aoki, Antonio Klasan, Justin J Ernat
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引用次数: 0
Abstract
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 - October 2022. Inclusion criteria were surgically treated MLKIs, available operative reports, and mechanism of injury (PT vs NPT; 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 sub-analysis considers anterior/posterior cruciate ligament injury patterns.
Results: Two hundred (206) patients with MLKI were included (57 PT (28%) and 149 NPT (72%); 84 HE (41%) and 122 LE (59%)). Chondral injury incidence was greater in PT (53%) and HE (45%) compared to NPT (27%; p=0.004) and LE (26%; p=0.001) patients, respectively. Mean number of surfaces injured was higher in PT versus NPT (1.59 ±1.94 vs 0.77 ±1.58; p=0.002), and HE versus LE (1.48 ±1.99 vs 0.66 ±1.43; p<0.001), respectively. PT patients exhibited more chondral injuries of the medial femoral condyle (MFC) (39% vs. 15%; p<0.001), lateral femoral condyle (LFC) (21% vs. 10%; p=0.034), and medial tibial plateau (MTP) (33% vs. 14%; p=0.001) compared to NPT. HE patients exhibited more chondral injuries of the MFC (20% vs. 8%; p<0.001), LFC (19% vs. 9%; p=0.035), and MTP (33% vs. 14%; p=0.001). No differences were found in rates of meniscal tears or chondral injuries of the lateral tibial plateau or patellofemoral joint. Pattern of cruciate ligament injury pattern did not impact rates of any injuries.
Conclusion: MLKIs from HE and PT requiring definitive surgical treatment were associated with higher rates of chondral injury across more surfaces compared to 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: III; Retrospective comparative case series.
目的：比较高能（HE）与低能（LE）、多创伤性（PT）与非多创伤性（NPT）多韧带膝关节损伤（MLKI）机制下半月板和软骨损伤的发生率。方法：这项单机构回顾性研究纳入了2008年4月至2022年10月期间接受mlki治疗的患者。纳入标准为手术治疗的mlki、可用的手术报告和损伤机制(PT vs NPT；电子病历中的HE vs. LE)。评估软骨损伤的位置、分级及半月板损伤的大小。此外，亚分析考虑了前/后交叉韧带损伤模式。结果：纳入200例（206例）MLKI患者，其中PT 57例（28%），NPT 149例（72%）；HE 84例（41%），LE 122例（59%）。PT组（53%）和HE组（45%）的软骨损伤发生率高于NPT组（27%）；p=0.004)和LE (26%；P =0.001)。PT组的平均表面损伤数高于NPT组（1.59±1.94 vs 0.77±1.58）；p=0.002), HE vs LE(1.48±1.99 vs 0.66±1.43；结论：与NPT和LE机制相比，HE和PT的mlki分别与更高的软骨损伤发生率相关，这些损伤涉及更多的表面，需要明确的手术治疗。损伤发生的机制似乎并不影响半月板撕裂率，交叉韧带损伤模式也无关紧要。证据等级：III；回顾性比较病例系列。
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