{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T23:45:21Z","timestamp":1784072721140,"version":"3.55.0"},"reference-count":58,"publisher":"Wiley","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Multiligament knee injuries (MLKIs) involving the medial collateral ligament (MCL) present unique challenges in surgical management and postoperative rehabilitation. This systematic review and meta\u2010analysis aimed to evaluate postoperative patient\u2010reported outcomes in patients with MCL\u2010involved MLKIs, with a minimum follow\u2010up of 2 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search, registered in PROSPERO (CRD42022364292) of MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify surgical outcome\u2010based studies on MLKIs with MCL involvement, published between January 2000 and October 2024, with at least 2 years of follow\u2010up. Studies including nonoperative treatment, arthroplasty, paediatric populations and technique articles were excluded. Data extracted included study design, patient demographics, follow\u2010up duration, anatomical region of injury and graft reconstruction type. Patient\u2010reported outcomes included Lysholm score, International Knee Documentation Committee (IKDC) score and Tegner activity scale. A random\u2010effects meta\u2010analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After applying inclusion and exclusion criteria, 20 studies with a total of 479 patients (all with MCL\u2010involved MLKIs) were included. The mean patient age at surgery was 35.6 years, and the average follow\u2010up was 4.1 years (range 2\u201312.7 years). At 2\u2010year follow\u2010up, the mean Lysholm score was 86.0 (95% confidence interval [CI]: 82.0\u201389.9) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). The mean IKDC score at 2 years was 75.8 (95% CI: 69.4\u201382.2) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients whose injuries did not involve the posterior cruciate ligament (PCL) demonstrated significantly higher IKDC scores than those with PCL involvement (92.0 vs. 71.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Lysholm scores followed a similar pattern (92.0 vs. 84.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). Overall, these findings indicate that PCL\u2010based medial\u2010sided MLKIs have poorer functional outcomes than those without PCL involvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>According to this meta\u2010analysis of MCL\u2010involved MLKIs with a minimum 2\u2010year follow\u2010up, patients can expect to maintain around 75%\u201380% of knee function at 2 years. Notably, MCL\u2010involved MLKIs without PCL involvement demonstrated higher IKDC and Lysholm scores compared with those who had combined MCL\u2010PCL injuries, underscoring the greater complexity and poorer prognosis associated with PCL\u2010based MLKIs.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      PROSPERO Registration number: CRD42022364292.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70232","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T13:01:51Z","timestamp":1767186111000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Posterior cruciate ligament involvement leads to inferior outcomes in multiligament knee injuries involving the medial collateral ligament: A systematic review and meta\u2010analysis"],"prefix":"10.1002","author":[{"given":"Collin Donald Roy","family":"Hunter","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery University of Utah Health Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Sternbauer","sequence":"additional","affiliation":[{"name":"Johannes Kepler University Linz Linz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kammerlander","sequence":"additional","affiliation":[{"name":"AUVA UKH Steiermark Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Grillari","sequence":"additional","affiliation":[{"name":"Ludwig Boltzmann Institute for Traumatology The Research Center in Cooperation With AUVA Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ortrun","family":"Neuper","sequence":"additional","affiliation":[{"name":"Ludwig Boltzmann Institute for Traumatology The Research Center in Cooperation With AUVA Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin J.","family":"Ernat","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery University of Utah Health Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0819-4706","authenticated-orcid":false,"given":"Antonio","family":"Klasan","sequence":"additional","affiliation":[{"name":"Johannes Kepler University Linz Linz Austria"},{"name":"AUVA UKH Steiermark Graz 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