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MRI diagnosis in multiligamentous injuries of knee with associated dislocations and neurovasacular sequelae: a retrospective analysis of injury patterns
Egyptian Rheumatology and Rehabilitation volume 46, pages 278–284 (2019)
Abstract
Background
Simultaneous injury of two or more knee ligaments with concurrent tears involving the anterior cruciate and medial collateral ligaments is considered to be associated with femorotibial knee dislocations (KD). The purpose of this study is to characterize multiligamentous knee injury patterns associated with dislocations on MRI and to describe the incidence of their sequelae such as tibial plateau fractures, peroneal nerve injuries, and posterolateral corner (PLC) injuries.
Participants and methods
After obtaining institutional ethical committee approval, we retrospectively identified 108 multiligamentous knee injuries in 100 patients who met with trauma and were treated at our tertiary care center between April 2014 and December 2018. Descriptive statistics were reported using numbers and percentages for categorical variables in cases of multiligamentous injuries, ipsilateral tibial plateau fractures, ipsilateral femoral fractures, peroneal nerve injury, arterial injury, compartment syndrome, and PLC injuries.
Results
The most common (39.8%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and PLC. Schenck KD III-M was the most common injury type in KD, constituting 16.7%. Medial-sided injuries were the most common injury patterns seen with KD. There was a significant risk of peroneal nerve injury with lateral-sided injuries.
Conclusion
KD, though rare, may have devastating clinical sequelae such as compartment syndrome if not recognized and treated. Therefore, it is necessary to recognize imaging findings of femorotibial joint dislocations and associated injuries to the adjacent neurovascular bundles.
References
Rihn JA, Groff YJ, Harner CD, Cha PS. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 2004; 12:334–346.
Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma 2013; 27:226–231.
Zhang Y, Zhang X, Hao Y, Zhang YM, Wang M, Zhou Y, et al. Surgical management of the multiple-ligament injured knee: a case series from Chongqing, China and review of published reports. Orthop Surg 2013; 5:239–249.
Rochecongar G, Plaweski S, Azar M, Demey G, Arndt J, Louis ML, et al. French Society for Arthroscopy (Société française d’arthroscopie, SFA). Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review. Orthop Traumatol Surg Res 2014; 100:S371–S378.
Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 2003; 17:198–202.
Cook S, Ridley TJ, McCarthy MA, Gao Y, Wolf BR, Amendola A, et al. Surgical treatment of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc 2015; 23:2983–2991.
Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral corner of the knee: current concepts. Arch Bone Jt Surg 2016; 4:97–103.
Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am 1963; 45:889–904.
Schenck RC, Hunter RE, Ostrum RF, Perry CR. Knee dislocations. Instr Course Lect 1999; 48:515–522.
Boisgard S, Versier G, Descamps S, Lustig S, Trojani C, Rosset P, et al. Bicruciate ligament lesions and dislocation of the knee: mechanisms and classification. Orthop Traumatol Surg Res 2009; 95:627–631.
Ríos A, Villa A, Fahandezh H, deJosé C, Vaquero J. Results after treatment of traumatic knee dislocations. A report of 26 cases. J Trauma 2003; 55:489–494.
Sisto DJ, Warren RF. complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985; 198:94–101.
Johnson ME, Foster L, DeLee JC. Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med 2008; 36:2448–2462.
Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br 2006; 88:706–711.
Baltodano PA, Tong AJ, Chhabra A, Rosson GD. The role of magnetic resonance neurography in the postoperative management of peripheral nerve injuries. Neuroimaging Clin N Am 2014; 24:235–244.
Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br 2005; 87B:664–667.
Bottomley N, Williams A, Birch R, Noorani A, Lewis A, Lavelle J. Displacement of the common peroneal nerve in posterolateral corner injuries of the knee. J Bone Joint Surg Br 2005; 87:1225–1226.
Lustig S, Leray E, Boisrenoult P, Trojani C, Laffargue P, Saragaglia D, et al. Dislocation and bicruciate lesions of the knee. Epidemiology and acute stage assessment in a prospective series. Orthop Traumatol Surg Res 2009; 95:614–620.
Stannard JP, Bauer KL. Current concepts in knee dislocations: PCL, ACL, and medial sided injuries. J Knee Surg 2012; 25:287–294.
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Ravikanth, R., Abraham, M.J., Pilar, A. et al. MRI diagnosis in multiligamentous injuries of knee with associated dislocations and neurovasacular sequelae: a retrospective analysis of injury patterns. Egypt Rheumatol Rehabil 46, 278–284 (2019). https://doi.org/10.4103/err.err_22_19
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DOI: https://doi.org/10.4103/err.err_22_19