Original articles
Intra-articular findings in the reconstructed multiligament-injured knee

https://doi.org/10.1016/j.arthro.2004.12.012Get rights and content

Purpose: Intra-articular chondral and meniscal injury in the multiligament-injured knee has not been examined. The purpose of this study was to determine the pattern of intra-articular chondral and meniscal damage in subjects with multiligament knee injuries undergoing surgery. Type of study: Prospective cohort study. Methods: Analysis was performed on prospectively collected data for the presence of meniscal tears and significant chondral injury on subjects who underwent knee ligament surgery. Subjects were grouped by their multiligament injury combination. Chondral injury was graded using the Modified Outerbridge Classification system. Criteria for significant chondral defect were any grade 2 lesion involving 50% or more of condylar width and all grade 3 or 4 lesions. Groups with more than 10 subjects were compared against the anterior cruciate ligament (ACL)-only group. Results: Data were collected on 2,265 subjects. The ACL/medial collateral ligament (MCL) injury pattern was the most common multiligament injury, comprising 70.5% of all multiligament injuries. Lateral meniscal damage was significantly higher in the ACL/MCL group (P < .01). Medial meniscal damage was significantly lower in the ACL/MCL group (P < .01). Medial and lateral meniscal damage was significantly lower in the ACL/lateral collateral ligament (LCL) group (P < .01). Articular damage to the medial tibial plateau was significantly lower in the ACL/MCL group (P < .01). All other multiligament injury patterns showed chondral damage similar to the ACL-only group. Ligament injuries repaired acutely had significantly less articular and medial meniscal damage than chronic repairs (P < .01). Conclusions: The ACL/MCL injury pattern was the most common multiligament injury pattern and showed a high incidence of lateral meniscal tears. ACL/LCL injuries had fewer meniscal injuries. Multiligament-injured knees showed increased risk of a torn medial meniscus as chronicity increased. Level of evidence: Level IV.

Section snippets

Methods

Knee ligament surgeries performed by 2 surgeons from Vanderbilt University (664 subjects), 2 surgeons from the Cleveland Clinic Foundation (723 subjects), and 1 surgeon from The Ohio State University (878 subjects) who are members of the MOON group, were included in this study. Vanderbilt University and The Ohio State University are level 1 trauma centers and the Cleveland Clinic Foundation is a referral center. Data included in this study were collected from 1990 to 2000. Intra-articular

Results

A total of 2,265 patients were included in this query. A breakdown showing the number of patients in each tear group is summarized in Table 2. The ACL/MCL injury pattern was the most common multiligament injury, comprising 70.5% of all multiligament injuries in our series.

Discussion

It should be noted that this study only included subjects who underwent knee ligament reconstruction surgery. Of a total of 2,265 subjects who presented for surgery, only 11% involved multiple knee injuries. A total of 70.5% of these multiligament injuries involved the ACL and MCL, making it the most common multiligament injury pattern. ACL/MCL injuries have been well studied; this tends to be a significant injury pattern. Duncan et al.5 found 38% of patients who underwent arthroscopic knee

Conclusions

The ACL/MCL injury pattern is the most common of all multiligament injuries. Adding an MCL injury to an ACL injury increases the risk of a torn lateral meniscus. Adding an LCL injury to an ACL injury decreases the risk of either a torn medial or lateral meniscus. An ACL/LCL combined injury is not the mirror image of an ACL/MCL injury. Increased risk of a torn medial meniscus seen in the ACL-deficient knee, as chronicity increased, continues to be true in the multiligament-injured knee.

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