title: Simultaneous bilateral multiligamentous knee injuries are associated with more severe multisystem trauma compared to unilateral injuries.
abstract: OBJECTIVE
  To compare the knee ligamentous injury patterns and associated multisystem trauma in patients who have sustained simultaneous bilateral knee multiligamentous injuries (MLI) to patients with unilateral MLIs.
  
  
  METHODS
  Patients with simultaneous bilateral and unilateral knee MLIs after motor vehicle accidents were identified from 2007 to 2014 at a single institution. Chart and radiographic reviews were performed to identify patient demographics, extremity fractures and associated head, thoracic, abdominal and spine injuries. The MLIs were characterized by ligamentous injury pattern and associated neurovascular deficits. Injury Severity Score (ISS) and New ISS (NISS) were calculated.
  
  
  RESULTS
  Seven bilateral MLIs and 32 unilateral MLIs were identified. Between the cohorts, there were no significant differences in ligamentous injury pattern or associated neurovascular injuries. For the bilateral MLI cohorts, 71.4 % of patients sustained chest trauma, 57.1 % abdominal trauma, 57.1 % at least a single-level spine injury and 28.6 % head trauma. The ISS was 33.4 ± 23.4 with patients spending an average of 12.4 days in the intensive care unit. Other than the number of days in the ICU, these values were all significantly higher than those of the unilateral knee MLI cohort. Additionally, there was a significantly higher post-operative complication rate in the bilateral MLI cohort (71.4 vs. 6.3 %, P < 0.0001).
  
  
  CONCLUSIONS
  Compared to unilateral MLIs with similar mechanisms, patients with traumatic simultaneous bilateral knee multiligamentous knee injuries are at high risk of concomitant head, chest and abdominal injuries. Although the ligament injury profile is similar, the post-operative complication rate is higher for simultaneous bilateral injuries.
  
  
  METHODS
  Case control study, Level III.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, HSC, PO Box 800159, Charlottesville, VA, 22908, USA.
authors.forename: M Tyrrell
authors.initials: MT
authors.lastname: Burrus
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, HSC, PO Box 800159, Charlottesville, VA, 22908, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, HSC, PO Box 800159, Charlottesville, VA, 22908, USA.
authors.forename: Jourdan M
authors.initials: JM
authors.lastname: Cancienne
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, HSC, PO Box 800159, Charlottesville, VA, 22908, USA. MDM3P@virginia.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008297:Male; D009104:Multiple Trauma; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Dislocation; Knee; Multiligamentous; Reconstruction; Trauma