Surgically Treated Multiligamentous Knee Injuries with LCL Disruption and Vascular Injury Demonstrate Higher Incidence of Peroneal Nerve Injury.

Abstract

Purpose: The purpose of this study is to clarify which specific ligamentous constellations predispose patients to peroneal nerve or vascular injuries in MLKIs.

Methods: This is a retrospective review of patients who underwent surgical treatment for MLKI, defined as having at least two ligaments (anterior cruciate ligament, ACL; posterior cruciate ligament, PCL; medial collateral ligament, MCL; lateral collateral ligament, LCL) surgically reconstructed or repaired due to identified injury and laxity, between April 2008 and August 2024. Demographic data and clinical records were obtained, and injury patterns were categorized based on individual ligament involvement (ACL/MCL, ACL/LCL, PCL/MCL, PCL/LCL, ACL/PCL, ACL/PCL/MCL, ACL/PCL/LCL, and ACL/PCL/MCL/LCL). Chi-squared analysis and binary logistic regression were performed to evaluate the association between ligament patterns and neurovascular injury risk, adjusting for age, sex, and body mass index (BMI).

Results: 171 patients were included (mean age 24 years), with 23% sustaining a peroneal nerve injury, and 3% sustaining a vascular injury requiring surgical repair. Peroneal nerve injuries were significantly more common in MLKIs involving the ACL/LCL (41%) and ACL/LCL/PCL (53%) compared to other patterns. Binary logistic regression revealed that LCL involvement was associated with an 8-fold increase in peroneal nerve injury risk (OR = 8.042, p = 0.003), while male sex (OR = 2.870, p = 0.032) and higher BMI (OR = 1.082, p = 0.008) were also significant predictors. Six of eleven patients (55%) with vascular injuries sustained concurrent peroneal nerve injury (OR, 6.34; 95% CI, 1.64-24.48; P = .007). No significant predictors were found for vascular injury.

Conclusion: Among patients with MLKIs, involvement of the lateral collateral ligament (LCL) confers an 8-fold higher risk of peroneal nerve injury, with additional risk factors including male sex and elevated BMI. Although no specific predictors were identified for lower extremity vascular injuries, patients with such injuries were more likely to experience concomitant peroneal nerve injury. These findings underscore the need for heightened clinical vigilance for peroneal nerve injury in MLKIs involving the LCL or in the presence of vascular injuries.

Level of evidence: IV; retrospective prognostic case series.