Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation

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 <i>British Journal of Sports Medicine</i> 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.

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Publication Details

Journal
British Journal of Sports Medicine
Published
2024-09-05
DOI
https://doi.org/10.1136/bjsports-2024-108089
Citations
25
Primary Topic
Knee injuries and reconstruction techniques
Type
article
Field-Weighted Citation Impact
14.32

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article

Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation

María Tuca, Christopher J. Wahl, Travis G. Maak, Gregory C. Fanelli et al.
25 citations
British Journal of Sports Medicine
Knee injuries and reconstruction techniques
14.32
article

Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation

María Tuca, Christopher J. Wahl, Travis G. Maak, Gregory C. Fanelli, Hege Grindem, Nicolas Pujol, Navnit S. Makaram, Romain Seil, Robert C. Schenck, Michael J. Medvecky, Michelle E. Kew, George F. Rick Hatch, Gilbert Moatshe, Lars Fredrik Engebretsen, Bruce A. Levy, Carolyn A. Emery, Aileen M. Davis, James J. Irrgang, James P. Stannard, Aaron John Krych, Jorge A. Chahla, Evert A.L.M. Verhagen, Volker Musahl, Dina C. Janse van Rensburg, K. Donald Shelbourne, James L. Cook, Andrew G. Geeslin, Daniel B. Whelan, Kristian Thorborg, Kay M. Crossley, Enda King, Iain Robert Murray, Robert F. LaPrade, Michael Tobias Hirschmann, Hollis G. Potter, Robert G. Marx, Michael J. Stuart, Frank R. Noyes, Peter MacDonald, Mark D. Miller, Chris Harner, SeungPyo Eun
article en
25 citations

Abstract

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 <i>British Journal of Sports Medicine</i> 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.

British Journal of Sports MedicineVol. 58(23)
Oslo University Hospital (NO), Hospital for Special Surgery (US), St. Michael's Hospital (CA), Mayo Clinic (US), Center for Devices and Radiological Health (US), Orlando Health (US), Pontificia Universidad Católica de Chile (CL), Centre Hospitalier de Luxembourg (LU), University of Calgary (CA), University of New Mexico (US), University of Pittsburgh (US), University of Toronto (CA), La Trobe University (AU), Cornell University (US), University of Utah (US), Keck Hospital of USC (US), Amager Hospital (DK), University of Vermont Medical Center (US), Yale University (US), Qatar Orthopaedic and Sports Medicine Hospital (QA), Luxembourg Institute of Health (LU), Twin Cities Orthopedics (US), Oslo Sports Trauma Research Center (NO), Dr Youth Clinic (KR), Cincinnati Sportsmedicine and Orthopaedic Center (US), Kantonsspital Baselland Standort Bruderholz (CH), Community Hospital (US), Centre Hospitalier de Versailles (FR), Health & Safety in Sports (NL), University of Manitoba (CA), Rush University (US), University of Virginia (US), University of Pretoria (ZA), Geisinger Commonwealth School of Medicine (US), University of Missouri (US), Vrije Universiteit Amsterdam (NL), University of Edinburgh (GB)
U.S. Department of Defense, USA Hockey Foundation, Arthrex, Stryker, American Orthopaedic Society for Sports Medicine, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine
Openalex Percentile: Top 1%
Knee injuries and reconstruction techniques
14.32
DOIOpen Access PDFOpenAlex
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