2015 ISAKOS Biennial Congress ePoster #1108
Meniscal Tears and Articular Cartilage Damage in the Multi-Ligament Injured/Dislocated Knee
Aaron J. Krych, MD, Rochester, MN UNITED STATES
Paul L. Sousa, MBA, Rochester, MN UNITED STATES
Alexander Harrison King, BS, Rochester, MN UNITED STATES
William M. Engasser, MD, Rochester, MN UNITED STATES
Michael J. Stuart, MD, Rochester, MN UNITED STATES
Bruce A. Levy, MD, Rochester, MN UNITED STATES
Mayo Clinic, Rochester, MN, USA
FDA Status Not Applicable
Summary: Cartilage injuries are a frequent occurrence in the setting of knee dislocation, and delayed reconstruction is associated with higher rates of injury.
Knee dislocations can cause significant damage to intra-articular knee structures, but currently there is limited data reporting articular-cartilage and meniscal injury in this setting. The purpose of this study is to 1) report the rate of concomitant intra-articular injuries at the time of multiligament reconstruction for knee dislocation, 2) determine if the pattern of ligament injury is associated with the presence of chondral and meniscal injuries, and 3) assess the relationship between timing of surgery and incidence of chondral and meniscal injuries.
The records of patients who underwent surgical treatment of multiligament knee injury between 1992 and 2013 were retrospectively reviewed. Patients included had a PCL-based multiligament knee injury or a minimum of three disrupted ligaments, both indicative of knee dislocation. Patient demographics, ligament injury patterns, meniscal tears and chondral injuries at arthroscopy, and interval from injury to surgery were recorded. Early surgical intervention was defined as less than 3 months, delayed was between 3-12 months, and chronic was greater than 12 months. Data analysis compared ligament injury pattern with chondral and meniscal injuries, as well as the rates of intraarticular injury by timing of surgery.
Of the 205 knees in our multiple-ligament database, 121 patients (122 knees) were included (93 males, 28 females) with a mean age at time of surgery of 32.1 years (range, 15-62). Ninety-three knees (76%) had associated chondral or meniscal injury. Sixty-seven knees (55%) presented with meniscal tears (26 isolated-medial, 27 isolated-lateral, and 14 combined-medial/lateral), while 52 knees (48%) had chondral damage, most common in the medial compartment. Schenck classification as well as side of injury did not demonstrate consistent relationships with intraarticular injury. A higher incidence of damage to the lateral-femoral condyle (20% vs 3%; p=0.02), lateral-tibial plateau (20% vs 2%; p<0.01, and patella (40% vs 13%; p=0.01) were found in the chronic group compared to the early group. The chronic group contained significantly more patients with bi- and tricompartmental chondral lesions (25% vs 6%; p=0.03 and 10 vs 0%; p=0.02, respectively).
Meniscal tears and chondral damage occur frequently in patients with a multiple ligament injured/dislocated knee. A longer interval from injury to surgical reconstruction is associated with higher rates of articular cartilage lesions, and cartilage lesions in multiple compartments. Further research is necessary to determine if articular cartilage and meniscal damage negatively affect outcome for these already severe injuries.