title: Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center.
abstract: OBJECTIVE
  To characterize multiligamentous knee injury patterns and describe associated morbidities.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  One hundred two patients (106 knees) with multiligamentous knee injuries and/or dislocations from 2000 through 2008. Subgroup of 82 knees with appropriate magnetic resonance images available assessed for ligamentous injury patterns.
  
  
  METHODS
  Data obtained from medical records for 106 knees.
  
  
  METHODS
  Presence of arterial injuries, nerve injuries, associated fracture patterns, and whole-body morbidities.
  
  
  RESULTS
  The most common (43%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner. Twenty-five percent of knees had associated ipsilateral tibial plateau fractures, and 19% had associated ipsilateral femoral fractures. Peroneal nerve injury occurred in 25% of knees, arterial injury in 21%, and compartment syndrome in 16%. An intra-abdominal injury was present in 13% of patients, a severe closed head injury in 10%, and a symptomatic pulmonary embolism in 5%.
  
  
  CONCLUSIONS
  Nearly half the multiligamentous knee injuries involved the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner; one-fourth had associated ipsilateral tibial plateau fractures. The incidence of peroneal nerve injury (25%) was higher than previously reported (20%), whereas the incidence of arterial injury (21%) was comparable to previous reports (19%). Posterolateral corner injuries were more prevalent than previously reported and were highly associated with peroneal nerve injury. We found a substantial incidence of associated morbidities of the whole body. Multiligamentous knee injuries are a marker of concomitant trauma and should be closely evaluated at presentation and during the hospital course to allow for early intervention for life- or limb-threatening comorbidities.
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, Baltimore, MD, USA.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Becker
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Watson
authors.forename: James C
authors.initials: JC
authors.lastname: Dreese
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000209:etiology*; D008023:Ligaments, Articular / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000209:etiology; D016119:Posterior Cruciate Ligament / Q000293:injuries; D012189:Retrospective Studies; D014193:Trauma Centers; D055815:Young Adult