{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:43:36Z","timestamp":1791564216187,"version":"4.3.4"},"reference-count":47,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2009,4,1]],"date-time":"2009-04-01T00:00:00Z","timestamp":1238544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2009,4,1]],"date-time":"2009-04-01T00:00:00Z","timestamp":1238544000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2009,4,1]],"date-time":"2009-04-01T00:00:00Z","timestamp":1238544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2009,4,1]],"date-time":"2009-04-01T00:00:00Z","timestamp":1238544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2009,4]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      The purpose of this systematic review was to address the treatment of multiligament knee injuries, specifically (\n                      <jats:italic>1<\/jats:italic>\n                      ) surgical versus nonoperative treatment, (\n                      <jats:italic>2<\/jats:italic>\n                      ) repair versus reconstruction of injured ligamentous structures, and (\n                      <jats:italic>3<\/jats:italic>\n                      ) early versus late surgery of damaged ligaments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Two independent reviewers performed a search on PubMed from 1966 to August 2007 using the terms \u201cknee dislocation,\u201d \u201cmultiple ligament\u2013injured knee,\u201d and \u201cmultiligament knee reconstruction.\u201d Study inclusion criteria were (\n                      <jats:italic>1<\/jats:italic>\n                      ) levels I to IV evidence, (\n                      <jats:italic>2<\/jats:italic>\n                      ) \u201cmultiligament\u201d defined as disruption of at least 2 of the 4 major knee ligaments, (\n                      <jats:italic>3<\/jats:italic>\n                      ) measures of functional and clinical outcome, and (\n                      <jats:italic>4<\/jats:italic>\n                      ) minimum of 12 months' follow\u2010up, with a mean of at least 24 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four studies compared surgical treatment with nonoperative treatment. There was a higher percentage of excellent\/good International Knee Documentation Committee (IKDC) scores (58%\n                      <jats:italic>v<\/jats:italic>\n                      20%) in surgically treated patients, as well as higher rates for return to work (72%\n                      <jats:italic>v<\/jats:italic>\n                      52%) and return to full sport (29%\n                      <jats:italic>v<\/jats:italic>\n                      10%). Two studies compared repair with reconstruction of damaged structures, with similar mean Lysholm scores (88\n                      <jats:italic>v<\/jats:italic>\n                      87) and excellent\/good IKDC scores (51%\n                      <jats:italic>v<\/jats:italic>\n                      48%). However, repair of the posterolateral corner had a higher failure rate (37%\n                      <jats:italic>v<\/jats:italic>\n                      9%). Similarly, repair of the cruciates yielded decreased stability and range of motion and a lower return to preinjury activity levels (0%\n                      <jats:italic>v<\/jats:italic>\n                      33%). There were 5 studies comparing early surgery (\u22643 weeks) with late surgery. Early treatment resulted in higher mean Lysholm scores (90\n                      <jats:italic>v<\/jats:italic>\n                      82) and a higher percentage of excellent\/good IKDC scores (47%\n                      <jats:italic>v<\/jats:italic>\n                      31%), as well as higher sports activity scores (89\n                      <jats:italic>v<\/jats:italic>\n                      69) on the Knee Outcome Survey.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our review suggests that early operative treatment of the multiligament\u2010injured knee yields improved functional and clinical outcomes compared with nonoperative management or delayed surgery. Repair of the posterolateral corner may yield higher revision rates compared with reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2009.01.008","type":"journal-article","created":{"date-parts":[[2009,4,1]],"date-time":"2009-04-01T05:03:34Z","timestamp":1238562214000},"page":"430-438","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":428,"title":["Decision Making in the Multiligament\u2010Injured Knee: An Evidence\u2010Based Systematic Review"],"prefix":"10.1002","volume":"25","author":[{"given":"Bruce A.","family":"Levy","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled A.","family":"Dajani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Whelan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Stannard","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Alabama Birmingham Alabama U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory C.","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Geisinger Medical Center Danville Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Stuart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel L.","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Minnesota Minneapolis Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Marx","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,4,1]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200409000-00008"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/otsm.2001.21769"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5919(05)70218-0"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2005.01.001"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199102000-00024"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.184.1.1609074"},{"key":"e_1_2_2_8_2","first-page":"450","article-title":"Complete dislocations of the knee with popliteal vascular injury","volume":"21","author":"Welling R.E.","year":"1981","journal-title":"J Trauma"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)36451-9"},{"key":"e_1_2_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199312000-00013"},{"key":"e_1_2_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2004.12.013"},{"key":"e_1_2_2_12_2","first-page":"554","article-title":"Vascular and orthopedic complications of knee dislocation","volume":"149","author":"Jones R.E.","year":"1979","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_2_13_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.54B1.96"},{"key":"e_1_2_2_14_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197557030-00031"},{"key":"e_1_2_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465990270021301"},{"key":"e_1_2_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500608"},{"key":"e_1_2_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000043921.09208.76"},{"key":"e_1_2_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659502300511"},{"key":"e_1_2_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(96)90213-3"},{"key":"e_1_2_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199904000-00023"},{"key":"e_1_2_2_21_2","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-199009040-00005"},{"key":"e_1_2_2_22_2","first-page":"97","article-title":"Orthopedic management of knee dislocations. 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