{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:18:48Z","timestamp":1792034328679,"version":"4.4.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aims to evaluate relationships among multiple ligament knee injury (MLKI) patterns as classified according to the knee dislocation (KD) classification and the types of surgical management pursued. We hypothesized that the KD classification would not be predictive of the types of surgical management, and that categorizing injuries according to additional injury features such as structure, chronicity, grade, and topographic location would be predictive of the types of surgical management. This is a Retrospective cohort study. This study was conducted at a level I trauma center with a 150-mile coverage radius. Query of our billing database was performed using combinations of 43 billing codes (International Classification of Diseases [ICD] 9, ICD-10, and Current Procedural Terminology) to identify patients from 2011 to 2015 who underwent operative management for MLKIs. There were operative or nonoperative treatment for individual ligamentous injuries, repair, or reconstruction of individual ligamentous injuries, and staging or nonstaging or nonstaging of each surgical procedure. The main outcome was the nature and timing of clinical management for specific ligamentous injury patterns. In total, 287 patients were included in this study; there were 199 males (69.3%), the mean age was 30.2\u2009years (SD: 14.0), and the mean BMI was 28.8\u2009kg\/m2 (SD: 7.4). There were 212 injuries (73.9%) categorized as either KD-I or KD-V. The KD classification alone was not predictive of surgery timing, staging, or any type of intervention for any injured ligament (p\u2009&gt;\u20090.05). Recategorization of injury patterns according to structure, chronicity, grade, and location revealed the following: partial non-ACL injuries were more frequently repaired primarily (p\u2009&lt;\u20090.001), distal medial-sided injuries were more frequently treated operatively than proximal medial-sided injuries (odds ratio [OR]\u2009=\u200924.7; p &lt;0.0001), and staging was more frequent for combined PCL-lateral injuries (OR\u2009=\u20091.3; p\u2009=\u20090.003) and nonavulsive fractures (OR\u2009=\u20091.2; p\u2009=\u20090.0009). The KD classification in isolation was not predictive of any surgical management strategy. Surgical management was predictable when specifying the grade and topographic location of each ligamentous injury. This is a Level IV, retrospective cohort study.<\/jats:p>","DOI":"10.1055\/s-0039-1695739","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T00:06:49Z","timestamp":1584490009000},"page":"273-279","source":"Crossref","is-referenced-by-count":14,"title":["Multiple Ligament Knee Injuries: Does the Knee Dislocation Classification Predict the Type of Surgical Management?"],"prefix":"10.1055","volume":"34","author":[{"given":"Garrett T.","family":"Maxwell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Warth","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeet","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Darlow","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lane","family":"Bailey","sequence":"additional","affiliation":[{"name":"Ironman Sports Medicine Institute, Memorial Hermann Medical System, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter R.","family":"Lowe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas"},{"name":"Ironman Sports Medicine Institute, Memorial Hermann Medical System, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Harner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas"},{"name":"Ironman Sports Medicine Institute, Memorial Hermann Medical System, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,3,17]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"2983","DOI":"10.1007\/s00167-014-3451-1","article-title":"Surgical treatment of multiligament knee injuries","volume":"23","author":"S Cook","year":"2015","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arthro.2009.01.008","article-title":"Decision making in the multiligament-injured knee: an evidence-based systematic review","volume":"25","author":"B A Levy","year":"2009","journal-title":"Arthroscopy"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1007\/s11999-014-3653-3","article-title":"Epidemiology of multiligament knee reconstruction","volume":"472","author":"S M Wilson","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/JSA.0b013e3182107d5f","article-title":"Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review","volume":"19","author":"C J Peskun","year":"2011","journal-title":"Sports Med Arthrosc Rev"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1177\/0363546513508375","article-title":"Ultra-low velocity knee dislocations: patient characteristics, complications, and outcomes","volume":"42","author":"B C Werner","year":"2014","journal-title":"Am J Sports Med"},{"key":"ref6","first-page":"127","article-title":"The dislocated knee","volume":"43","author":"R C Schenck Jr","year":"1994","journal-title":"Instr Course Lect"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/00005131-199710000-00011","article-title":"Knee dislocation: initial assessment and implications for treatment","volume":"11","author":"D C Wascher","year":"1997","journal-title":"J Orthop Trauma"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.arthro.2009.07.009","article-title":"The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis","volume":"26","author":"J Davidson","year":"2010","journal-title":"Arthroscopy"},{"key":"ref9","first-page":"293","article-title":"Fractures of the femur after hip replacement","volume":"44","author":"C P Duncan","year":"1995","journal-title":"Instr Course Lect"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1177\/036354659402200511","article-title":"Fate of the ACL-injured patient. A prospective outcome study","volume":"22","author":"D M Daniel","year":"1994","journal-title":"Am J Sports Med"},{"issue":"263","key":"ref11","first-page":"200","article-title":"Dislocation of the knee","author":"F J Frassica","year":"1991","journal-title":"Clin Orthop Relat Res"},{"issue":"198","key":"ref12","first-page":"94","article-title":"Complete knee dislocation. A follow-up study of operative treatment","author":"D J Sisto","year":"1985","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1177\/036354659602400309","article-title":"Primary repair for posterior cruciate ligament injuries. An eight-year followup of fifty-three patients","volume":"24","author":"M Richter","year":"1996","journal-title":"Am J Sports Med"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/01.TA.0000043921.09208.76","article-title":"Results after treatment of traumatic knee dislocations: a report of 26 cases","volume":"55","author":"A R\u00edos","year":"2003","journal-title":"J Trauma"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1007\/s00167-003-0490-4","article-title":"Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes","volume":"12","author":"C H Wong","year":"2004","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref16","first-page":"33","article-title":"Operative versus nonoperative treatment of knee dislocations: a meta-analysis","volume":"14","author":"B T Dedmond","year":"2001","journal-title":"Am J Knee Surg"},{"key":"ref17","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195305234.001.0001","volume-title":"Clinical Epidemiology: The Study of the Outcome of Illness","author":"N S Weiss","year":"2006"},{"issue":"09","key":"ref18","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.1007\/s11999-014-3707-6","article-title":"Long-term followup of surgically treated knee dislocations: stability restored, but arthritis is common","volume":"472","author":"G C Fanelli","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1016\/j.arthro.2016.01.038","article-title":"Surgical outcomes of medial versus lateral multiligament-injured, dislocated knees","volume":"32","author":"A H King","year":"2016","journal-title":"Arthroscopy"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"3003","DOI":"10.1007\/s00167-015-3750-1","article-title":"Does age predict outcome after multiligament knee reconstruction for the dislocated knee? 2- to 22-year follow-up","volume":"23","author":"N M Levy","year":"2015","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"07","key":"ref21","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1053\/jars.2000.9240","article-title":"The treatment of complete posterior cruciate ligament tears","volume":"16","author":"F A Barber","year":"2000","journal-title":"Arthroscopy"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1055\/s-0036-1571427","article-title":"Knee dislocations and PCL-based multiligament knee injuries in patients aged 18\u2009years and younger: surgical technique and outcomes","volume":"29","author":"G C Fanelli","year":"2016","journal-title":"J Knee Surg"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/JSA.0b013e3182191c75","article-title":"Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee","volume":"19","author":"B A Levy","year":"2011","journal-title":"Sports Med Arthrosc Rev"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1177\/0363546509352459","article-title":"Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee","volume":"38","author":"B A Levy","year":"2010","journal-title":"Am J Sports Med"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1055\/s-0032-1324813","article-title":"Treatment of PCL, ACL, and lateral-side knee injuries: acute and chronic","volume":"25","author":"B A Levy","year":"2012","journal-title":"J Knee Surg"},{"issue":"04","key":"ref26","first-page":"214","article-title":"Comparison of surgical treatments for knee dislocation","volume":"12","author":"P P Mariani","year":"1999","journal-title":"Am J Knee Surg"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/BOT.0b013e3180321318","article-title":"Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years","volume":"21","author":"B D Owens","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"184","DOI":"10.2106\/JBJS.L.01603","article-title":"Hinged external fixation in the treatment of knee dislocations: a prospective randomized study","volume":"96","author":"J P Stannard","year":"2014","journal-title":"J Bone Joint Surg Am"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1695739.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T09:51:46Z","timestamp":1722592306000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1695739"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,17]]},"references-count":28,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2021,2,22]]},"published-print":{"date-parts":[[2021,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1695739","relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,17]]}}}