High-Energy and Polytraumatic Multiligament Knee Injuries Requiring Surgical Treatment Are Associated With More Chondral Damage yet Similar Rates of Meniscal Injury

IF 5.4 1区医学 Q1 ORTHOPEDICS Arthroscopy-The Journal of Arthroscopic and Related Surgery Pub Date : 2025-10-01 Epub Date: 2025-03-28 DOI:10.1016/j.arthro.2025.03.044

Collin D.R. Hunter B.S. , Joseph Featherall M.D. , Natalya McNamara M.D. , Benjamin T. Johnson B.S. , Patrick E. Greis M.D. , Travis G. Maak M.D. , Stephen K. Aoki M.D. , Antonio Klasan M.D., Ph.D., E.M.B.A, F.R.C.S. , Justin J. Ernat M.D., M.H.A., F.A.A.O.S

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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 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.

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需要手术治疗的高能量和多韧带膝关节损伤与更多的软骨损伤相关，但半月板损伤的发生率相似。

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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来源期刊

Arthroscopy-The Journal of Arthroscopic and Related Surgery 医学-外科

CiteScore

9.30

自引率

17.00%

发文量

555

审稿时长

58 days

期刊介绍： Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.