Background:Previous research has found that the incidence of neurovascular injury is greatest among multiligamentous knee injuries (MLKIs) with documented knee dislocation (KD). However, it is unknown whether there is a comparative difference in functional recovery based on evidence of a true dislocation.Purpose:To determine whether the knee dislocation-3 (KD3) injury pattern of MLKI with documented tibiofemoral dislocation represents a more severe injury than KD3 MLKI without documented dislocation, as manifested by poorer clinical outcomes at long-term follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:A multicenter retrospective cohort study was performed of patients who underwent surgical treatment for KD3 MLKI between May 2012 and February 2021. Outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale, and visual analog scale (VAS) for pain. Documented dislocation was defined as a radiographically confirmed tibiofemoral disarticulation, the equivalent radiology report from outside transfer, or emergency department documentation of a knee reduction maneuver. Subgroup analysis was performed comparing lateral (KD3-L) versus medial (KD3-M) injuries. Multivariable linear regression was conducted to determine whether documented dislocation was predictive of outcomes.Results:A total of 42 patients (25 male, 17 female) were assessed at a mean 6.5-year follow-up (range, 2.1-10.7 years). Twenty patients (47.6%) were found to have a documented KD; they reported significantly lower IKDC (49.9 vs 63.0; P = .043), Lysholm (59.8 vs 74.5; P = .023), and Tegner activity level (2.9 vs 4.7; P = .027) scores than the patients without documented dislocation. VAS pain was not significantly different between groups (36.4 vs 33.5; P = .269). The incidence of neurovascular injury was greater among those with documented dislocation (45.0% vs 13.6%; P = .040). Subgroup analysis found that patients with KD3-L injuries experienced a greater deficit in Tegner activity level than patients with KD3-M injuries (Δ: –3.4 vs −1.2; P = .006) and had an increased incidence of neurovascular injury (41.7% vs 11.1%; P = .042). Documented dislocation status was predictive of poorer IKDC (β = −2.15; P = .038) and Lysholm (β = −2.85; P = .007) scores.Conclusion:Patients undergoing surgical management of KD3 injuries with true, documented KD had significantly worse clinical and functional outcomes than those with nondislocated joints at a mean 6.5-year follow-up. The current MLKI classification based solely on ligament involvement may be obscuring outcome research by not accounting for true dislocation.

中文翻译：

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记录的膝关节脱位与多韧带膝损伤的临床和功能结果：平均 6.5 年随访时 KD3 损伤的比较

背景：之前的研究发现，在伴有膝关节脱位（KD）的多韧带膝损伤（MLKI）中，神经血管损伤的发生率最高。然而，基于真正脱位的证据，尚不清楚功能恢复是否存在比较差异。目的：确定记录有胫股脱位的 MLKI 的膝关节脱位 3 (KD3) 损伤模式是否代表比 KD3 更严重的损伤MLKI 没有记录的脱位，表现为长期随访时临床结果较差。研究设计：队列研究；证据级别，3。方法：对 2012 年 5 月至 2021 年 2 月期间因 KD3 MLKI 接受手术治疗的患者进行了一项多中心回顾性队列研究。使用国际膝关节文献委员会 (IKDC) 评分、Lysholm 评分、Tegner 活动度评估结果量表和疼痛视觉模拟量表（VAS）。记录的脱位被定义为经放射学证实的胫股离断、来自外部转移的等效放射学报告或膝关节复位操作的急诊室记录。进行亚组分析，比较外侧（KD3-L）与内侧（KD3-M）损伤。进行多变量线性回归以确定记录的脱位是否可以预测结果。结果：共有 42 名患者（25 名男性，17 名女性）在平均 6.5 年的随访（范围为 2.1-10.7 年）中进行了评估。20 名患者 (47.6%) 被发现患有 KD；他们报告称，与无脱位记录的患者相比，IKDC（49.9 vs 63.0；P = .043）、Lysholm（59.8 vs 74.5；P = .023）和 Tegner 活动水平（2.9 vs 4.7；P = .027）评分显着较低。VAS 疼痛在各组之间没有显着差异（36.4 vs 33.5；P = .269）。有脱位记录的患者神经血管损伤的发生率更高（45.0% vs 13.6%；P = .040）。亚组分析发现，KD3-L 损伤患者的 Tegner 活动水平比 KD3-M 损伤患者存在更大的缺陷（Δ：–3.4 vs -1.2；P = .006），并且神经血管损伤的发生率增加（41.7%） vs 11.1%；P = .042)。记录的脱位状态可预测较差的 IKDC (β = -2.15; P = .038) 和 Lysholm (β = -2.85; P = .007) 评分。 结论：接受 KD3 损伤手术治疗的患者，患有真实记录的 KD 显着降低在平均 6.5 年的随访中，其临床和功能结果比关节未脱位的患者更差。当前仅基于韧带受累情况的 MLKI 分类可能会因未考虑真正的脱位而掩盖结果研究。