Epidemiological Study on Multiligament Knee Injuries

Pinheiro, Igor Natário; Pedrinha, Igor Stefano Menescal; Maia, Phelippe Augusto Valente; Cortes, André Rodrigues de Oliveira; Albuquerque, Rodrigo Pires e; Barretto, João Maurício

doi:10.1055/s-0041-1731798

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Sumário

Original Article • Rev. bras. ortop. 57 (04) • Jul-Aug 2022 • https://doi.org/10.1055/s-0041-1731798 copy

Epidemiological Study on Multiligament Knee Injuries^* * Study developed at the Knee Specialized Care Center, Instituto Nacional de Traumatologia Jammil Haddad -INTO/MS, Rio de Janeiro, RJ, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present paper aims to describe multiligament knee injuries and to associate their features with the profile of the patients and trauma mechanisms.

Methods

This is a cross-sectional study evaluating 82 patients with multiligament knee injuries from September 2016 to September 2018. Evaluated parameters included age, gender, mechanical axis, affected side, range of motion, trauma mechanism, associated injuries, affected ligaments, and absence from work.

Results

The sample included patients aged between 16 and 58 years old, with an average age of 29.7 years old; most subjects were males, with 92.7% of cases. The most common trauma mechanism was motorcycle accident (45.1%). The most injured ligament was the anterior cruciate ligament (80.5%), followed by the posterior cruciate ligament (77.1%), the posterolateral corner (61.0%), and the tibial collateral ligament (26.8%). The most frequent type of dislocation was KD IIIL (30.4%). Only 1 patient had a vascular injury, and 13 (15.9%) presented with neurological injuries. Most subjects took medical leave from work (52.4%).

Conclusion

There is a big difference between patients with multiligament lesions in Brazil compared with international studies. Thus, it is advisable to carry out more specific studies on the topic with our population to improve the treatment of these patients.

Keywords
knee injuries; knee dislocation; joint instability

Classification	Injury
KD I	Injury involves only one cruciate ligament and a collateral ligament
KD II	Injury involves both cruciate ligaments
KD III M	Injury involves both cruciate ligaments and the tibial collateral ligament
KD III L	Injury involves both cruciate ligaments and the fibular collateral ligament
KD IV	All four ligaments are injured
KD V	Knee dislocation associated with fracture

Variable	Frequency
Variable	F	%
Gender
Female	6	7.3%
Male	76	92.7%
Age at injury (years old)
10 \|- 20	8	9.8%
20 \|-30	37	45.1%
30 \|-40	25	30.5%
40 \|- 50	9	11.0%
50 \|- 60	3	3.7%
Body classification according to BMI^*
Adequate	14	28.6%
Overweight	19	38.8%
Grade I obesity	12	24.5%
Grade II obesity	3	6.1%
Grade III obesity	1	2.0%
Injured knee
Right	39	47.6%
Left	43	52.4%
Axis
Neutral	39	47.5%
Valgus	15	18.3%
Varus	28	34.1%
Slap gait	10	12.2%
Buckling	12	14.6%
Fracture	22	26.8%
Dislocation	18	22.8%
Neurological Injury	13	15.9%
Vascular Injury	1	1.2%
Injury Type
KD I	19	23.1%
KD II	10	12.1%
KD III M	12	14.6%
KD III L	25	30.4%
KD IV	6	7.3%
KD V	10	12.1%
Range of Motion
- 5 to 110°	1	1.2%
- 5 to 140°	2	2.4%
- 5 to 128°	1	1.2%
0 to 70°	1	1.2%
0 to 90°	3	3.7%
0 to 100°	7	8.5%
0 to 105°	1	1.2%
0 to 110°	28	34.1%
0 to 120°	11	13.4%
0 to 130°	18	22.0%
0 to 135°	1	1.2%
0 to 136°	1	1.2%
0 to 140°	4	4.9%
5 to 100°	1	1.2%
10 to 110°	1	1.2%
20 to 100°	1	1.2%
Time away from work under INSS benefit	43	52.4%

Injury-generating mechanism	Global n= 82		Age < 30 years old n= 45		Age ≥ 30 years old
Injury-generating mechanism	Global n= 82		Age < 30 years old n= 45		n= 37
Motorcycle accident	37	45.1%	23	51.1%	14	37.8%
Car accident	9	11.0%	4	8.9%	5	13.5%
Soccer	9	11.0%	6	13.3%	3	8.1%
Fight	8	9.8%	3	6.6%	5	13.5%
Fall from height	6	7.3%	3	6.6%	3	8.1%
Running over	4	4.9%	1	2.2%	3	8.1%
Job-related accident	2	2.4%	2	4.4%	0	0.0%
Ox kick	2	2.4%	1	2.2%	1	2.7%
Fall from elevator	1	1.2%	0	0.0%	1	2.7%
Fall in hole	1	1.2%	0	0.0%	1	2.7%
Skate	1	1.2%	1	2.2%	0	0.0%
Paintball match	1	1.2%	0	0.0%	1	2.7%
Torsional trauma	1	1.2%	1	2.2%	0	0.0%

Injuries	Global n= 82		Age < 30 years old n= 45		Age ≥30 years old n= 37		p-value at the chi-squared test comparing frequencies from both age groups
Anterior cruciate ligament	66	80.50%	33	73.30%	33	89.20%	0.071
Posterior cruciate ligament	64	77.10%	33	73.30%	31	82.80%	0.408
CPL	50	61.0%	27	60.0%	23	73.00%	0.842
Medial collateral ligament	22	21.00%	10	22.20%	12	32.40%	0.299
Lateral collateral ligament	7	8.5%	5	11.1%	2	5.40%	0.449^*
Medial meniscus	21	25.60%	10	22.20%	11	29.70%	0.438
Lateral meniscus	12	14.60%	4	8.90%	8	21.60%	0.105
Fibular nerve	2	2.40%	0	0.00%	2	5.40%	0.201^*
Posterior plateau	1	1.20%	0	0.00%	1	2.70%	0.451^*
Biceps avulsion	1	1.20%	1	2.20%	0	0.00%	1.000^*

Dislocation and Fractures	Global n= 82	Age < 30 years old n= 45	Age ≥ 30 years old n= 37	chi-squared test comparing frequencies from both age groups
Knee dislocation	18 (22.0%)	7 (15.6%)	11 (29.7%)	0.180
At least one fracture	22 (26.8%)	12 (26.7%)	10 (27.0%)	0.908
Acetabular fracture	4 (4.9%)	2 (4.4%)	2 (5.4%)	1.000 ^*
Tibial fracture	4 (4.9%)	4 (8.9%)	0 (0.0%)	0.123^*
Ankle fracture	4 (4.9%)	1 (2.2%)	3 (8.1%)	0.323^*
Femoral fracture	3 (3.7%)	2 (4.4%)	1 (2.7%)	1.000^*
Knee fracture	3 (3.7%)	1 (2.2%)	2 (5.4%)	0.586^*
Tibial plateau fracture	2 (2.4%)	1 (2.2%)	1 (2.7%)	0.201^*
Compartmental syndrome	1 (1.2%)	1 (2.2%)	0 (0.0%)	1.000^*
Fibular fracture	1 (1.2%)	0 (0.0%)	1 (2.7%)	0.451^*
Medial malleolus fracture	1 (1.2%)	1 (2.2%)	0 (0.0%)	1.000^*
Tibial diaphyseal fracture	1 (1.2%)	1 (2.2%)	0 (0.0%)	1.000^*

Neurological Injury	Global n= 82	Age < 30 years old n= 45	Age ≥ 30 years old n= 37	p-value from the chi-squared test comparing frequencies from both age groups
Neurological injury	13 (15.9%)	8 (17.7%)	5 (13.5%)	0.599
Fibular nerve	12 (14.6%)	8 (17.7%)	4 (10.8%)	0.674^*
Tibial nerve	2 (1.2%)	2 (4.4%)	0 (0.0%)	0.451^*

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[1] Address for correspondence Igor Natário Pinheiro, MD, Instituto Nacional de Traumatologia Jammil Haddad -INTO/ MS, Rio de Janeiro, RJ, Brazil (e-mail: dr.igornatariop@gmail.com).

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Epidemiological Study on Multiligament Knee Injuries* * Study developed at the Knee Specialized Care Center, Instituto Nacional de Traumatologia Jammil Haddad -INTO/MS, Rio de Janeiro, RJ, Brazil

Abstract

Objective

Methods

Results

Conclusion

Epidemiological Study on Multiligament Knee Injuries^* * Study developed at the Knee Specialized Care Center, Instituto Nacional de Traumatologia Jammil Haddad -INTO/MS, Rio de Janeiro, RJ, Brazil