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

Autor:	Murray IR; Edinburgh Orthopaedics, Edinburgh, UK.; University of Edinburgh, Edinburgh, UK., Makaram NS; Edinburgh Orthopaedics, Edinburgh, UK.; University of Edinburgh, Edinburgh, UK., Geeslin AG; University of Vermont Medical Center, Burlington, Vermont, USA., Chahla J; Rush University, Chicago, Illinois, USA., Moatshe G; Orthopaedic Division, Oslo University Hospital, Oslo, Norway.; Oslo Sports Trauma Research Center, Oslo, Norway., Crossley K; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australian IOC Research Centre, Melbourne, Victoria, Australia., Kew ME; Hospital for Special Surgery, New York, New York, USA., Davis A; University of Toronto, Toronto, Ontario, Canada., Tuca M; Pontificia Universidad Catolica De Chile School of Medicine, Santiago, Chile., Potter H; Weill Cornell Medical College, New York, New York, USA., Janse van Rensburg DC; Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa.; Chair, Medical Advisory Panel, World Netball, Manchester, UK., Emery CA; Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Eun S; Dr. Eun's Korea Orthopaedic Clinic, Seoul, The Republic of Korea., Grindem H; Oslo Sports Trauma Research Center, Oslo, Norway., Noyes FR; Department of Orthopedic Surgery, Mercyhealth-Cincinnati Sports Medicine and Orthopedics, Cincinnati, Ohio, USA., Marx RG; Hospital for Special Surgery, New York, New York, USA., Harner C; Office of Orthopedic Devices, Office of Health Technology 6, Silverspring, Maryland, USA., Levy BA; Jewett Orthopedic Institute, Orlando Health, Orlando, Florida, USA., King E; Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar., Cook JL; Thompson Laboratory for Regenerative Orthopaedics, Mizzou Joint & Limb Preservation Center, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA., Whelan DB; St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Hatch GF 3rd; USC Keck School of Medicine, Los Angeles, California, USA., Wahl CJ; Surgical Sports Medicine and Trauma, Proliance Orthopedics & Sports Medicine, Seattle, Washington, USA., Thorborg K; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen (SORC-C), Amager - Hvidovre Hospital, Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark., Irrgang JJ; School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Pujol N; Department of Orthopedics, Centre Hospitalier de Versailles, Le Chesnay, France., Medvecky MJ; Section of Sports Medicine, Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA., Stuart MJ; Mayo Clinic, Rochester, Minnesota, USA., Krych AJ; Mayo Clinic, Rochester, Minnesota, USA., Engebretsen L; Orthopaedic Division, Oslo University Hospital, Oslo, Norway.; Oslo Sports Trauma Research Center, Oslo, Norway., Stannard JP; University of Missouri School of Medicine, Columbia, Missouri, USA., MacDonald P; University of Manitoba, Winnipeg, Manitoba, Canada., Seil R; Department of Orthopaedic Surgery, Centre Hopsitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.; Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.; Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg., Fanelli GC; Geisinger Orthopaedics and Sports Medicine, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA., Maak TG; University of Utah Health, Salt Lake City, Utah, USA., Shelbourne KD; Shelbourne Knee Center, Community Hospital East, Indianapolis, Indiana, USA., Verhagen E; Department of Public and Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, Amsterdam, Netherlands.; Movement Sciences, Amsterdam, University Medical Centres - Vrije Universiteit Amsterdam, Amsterdam, Netherlands., Musahl V; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Hirschmann MT; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland., Miller MD; Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, USA., Schenck RC; Department of Orthopedic Surgery and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA., LaPrade RF; Orthopedic Surgery, Twin Cities Orthopedics Edina-Crosstown, Edina, Minnesota, USA laprademdphd@gmail.com.
Jazyk:	angličtina
Zdroj:	British journal of sports medicine [Br J Sports Med] 2024 Sep 05. Date of Electronic Publication: 2024 Sep 05.
DOI:	10.1136/bjsports-2024-108089
Abstrakt:	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. Competing Interests: ompeting interests: IRM reports the following disclosures: Arthrex: paid consultant; Bone and Joint Research: editorial or governing board; Journal of Bone and Joint Surgery—British: editorial or governing board; Stryker: paid consultant. AG reports the following disclosures: American Orthopaedic Society for Sports Medicine: board or committee member; Arthroscopy: editorial or governing board, Infographics Editor; Ossur: paid presenter or speaker; Smith & Nephew: paid consultant; paid presenter or speaker. JC reports the following disclosures: American Orthopaedic Society for Sports Medicine: board or committee member; Arthrex: paid consultant; Arthroscopy Association of North America: board or committee member; Conmed Linvatec: paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; Ossur: paid consultant; Smith & Nephew: paid consultant. GM reports the following disclosures: Smith & Nephew: paid consultant; IBSA: paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; Arthroscopy: editorial board; JBJS: editorial board. RFLP reports the following disclosures: American Journal of Sports Medicine: editorial or governing board; American Orthopaedic Society for Sports Medicine: board or committee member; Arthrex: IP royalties; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; Journal of Experimental Orthopaedics: editorial or governing board; Knee Surgery, Sports Traumatology, Arthroscopy: editorial or governing board; Ossur: IP royalties, paid consultant, research support; Smith & Nephew: IP royalties, paid consultant; research support; Journal of Knee Surgery: editorial or governing board; Orthopaedic Techniques in Sports Medicine: editorial or governing board. JJI reports the following disclosures: receives funding as PI from Department of Defense Congressionally Directed Medical Research Programme Peer Reviewed Orthopaedic Research Programme for the Surgical Timing and Rehabilitation (STaR) Trial for Multiple Ligament Knee Injuries (MLKIs): A Multicenter Integrated Clinical Trial (W81XWH-17-2-0073) and serves as President, Board of Directors for Movement Science Media/Journal of Orthopaedic and Sports Physical Therapy. GM reports the following disclosures: Smith & Nephew, IBSA: consultant; ISAKOS: committee member; JBJS and arthroscopy: editorial board; Smith & Nephew: fellowship funding. GFH III reports the following disclosures: Arthrex: consultant. MS reports the following disclosures: Arthrex: consultant and royalties; Stryker, USA Hockey Foundation: research funding; MEK reports the following disclosures: AANA: research committee; AOSSM: enduring education committee; Arthrex; Smith & Nephew: education funds; PMacD reports the following disclosures: Arthrex and Conmed: consultant; Arthrex, Conmed, Zimmer Biomet, Smith & Nephew, Ossur: research and fellowship support; KMC reports the following disclosures: BJSM: senior advisor. BL reports the following disclosures: Arthrex: consultant and royalties; JKS and KSSTA: editorial board; MJM reports the following disclosures: Smith & Nephew: paid speaker. KT reports the following disclosure: Deputy Editor: BJSM. TGM reports the following disclosures: Arthrex: speaker, consultant; CORR: editorial board. EV reports the following disclosures: Associate Editor: BJSM; Editor-in-Chief: BMJ Open SEM. AJK reports the following disclosures: Arthrex: consultant, IP royalties; JRF Orthopaedics, Vericel, Responsive Arthroscopy: consulting fees; DJO: grants; Musculoskeletal Transplant Foundation: board of trustees. RCS reports the following disclosures: Arthrex: education; Editorial Board: AJSM and JBJS. JPS reports the following disclosures: Thieme: Publishing Royalties; DePuy: consulting fees/teaching courses; Arthrex: consulting fees/teaching courses; AO NA: research support, teaching and travel support; AO Foundation: teaching/travel support; Journal of Knee Surgery: Editor-in-Chief. CE reports the following disclosures: Canadian Institutes of Health Research, Canada Foundation for Innovation, Canada Research Chairs Programme and National Football League Play Smart Play Safe Programme: peer-reviewed research support; Associate Editor: BJSM; External Advisory Board: HitIQ Chairperson: Sport Injury Prevention Research Centre, an IOC Research Centre for Prevention of Injury and Protection of Athlete Health. HG reports the following disclosures: Associate Editor: BJSM, JOSPT. RGM reports the following disclosures: Mend nutrition. Royalties from Springer and Demos for books. JLC reports the following disclosures: AANA: research support; AO Trauma: research support; Arthrex: IP royalties; paid consultant; research support; Bioventus: paid consultant; Boehringer Ingelheim: paid consultant; Collagen Matrix: paid consultant; research support; GE Healthcare: research support; Journal of Knee Surgery: editorial or governing board; Midwest Transplant Network: board or committee member; Musculoskeletal Transplant Foundation: board or committee member; IP royalties; research support; National Institutes of Health (NIAMS & NICHD): research support; OREF: research support; Orthopaedic Trauma Association: research support; PCORI: research support; Regenosine: research support; SITES Medical: research support; Thieme: publishing royalties, financial or material support; Trupanion: paid consultant. VM reports the following disclosures: Smith & Nephew, Newclip: consultant; Ostesys: Shareholder; Arthrex, Smith & Nephew: educational grants; ISAKOS: board or committee member; KSSTA: Deputy Editor-in-Chief. MTH reports the following disclosures: Knee Surgery Sports Traumatology Arthroscopy (KSSTA): Deputy Editor-in-Chief; APKASS journal, MLT journal, Arthroskopie, Das Knie (DKG): board or committee member; European Knee Associates (EKA): Past Chairman; ESSKA Milan 2020 and 2021: Scientific Chairman; ISAKOS: Arthroplasty Committee; ESSKA: Cartilage Committee; German Knee Society: board or committee member; Personalized Arthroplasty Society (PAS): 2nd vice president DepuySynthes, Smith & Nephew, Symbios, Medacta: cconsultant; DepuySynthes, Finceramica, Symbios, Mathys, Arthrex, SIWF, Deutsche Arthrose-Hilfe, Bangerter-Rhyner-Stiftung: research grants. NM, HP, SPE, KDS, CJW, FRN, MT, DCCJvR, EK, DBW, MDM, GCF, CH, LE, RS and NP report no competing interests. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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