TY - JOUR
T1 - Multiligament knee injury (MLKI)
T2 - an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation
AU - Murray, Iain Robert
AU - Makaram, Navnit S.
AU - Geeslin, Andrew G.
AU - Chahla, Jorge
AU - Moatshe, Gilbert
AU - Crossley, Kay
AU - Kew, Michelle E.
AU - Davis, Aileen
AU - Tuca, Maria
AU - Potter, Hollis
AU - Janse van Rensburg, Dina C.
AU - Emery, Carolyn A.
AU - Eun, SeungPyo
AU - Grindem, Hege
AU - Noyes, Frank R.
AU - Marx, Robert G.
AU - Harner, Chris
AU - Levy, Bruce A.
AU - King, Enda
AU - Cook, James L.
AU - Whelan, Daniel B.
AU - Hatch, George F.
AU - Wahl, Christopher J.
AU - Thorborg, Kristian
AU - Irrgang, James J.
AU - Pujol, Nicolas
AU - Medvecky, Michael J.
AU - Stuart, Michael J.
AU - Krych, Aaron J.
AU - Engebretsen, Lars
AU - Stannard, James P.
AU - MacDonald, Peter
AU - Seil, Romain
AU - Fanelli, Gregory C.
AU - Maak, Travis G.
AU - Shelbourne, K. Donald
AU - Verhagen, Evert
AU - Musahl, Volker
AU - Hirschmann, Michael T.
AU - Miller, Mark D.
AU - Schenck, Robert C.
AU - LaPrade, Robert F.
N1 - Publisher Copyright:
© 2024 BMJ Publishing Group. All rights reserved.
PY - 2024
Y1 - 2024
N2 - Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined’a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
AB - Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined’a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
UR - https://www.scopus.com/pages/publications/85204450906
U2 - 10.1136/bjsports-2024-108089
DO - 10.1136/bjsports-2024-108089
M3 - Article
C2 - 39237264
SN - 0306-3674
JO - British journal of sports medicine
JF - British journal of sports medicine
ER -