Summary

This study has demonstrated significant differences between Posterolateral corner injuries sustained on the sports field and those sustained in a Road Traffic Accident, this may have implications for future treatment and studies of these complex injuries.

Abstract

Postero-lateral corner (PLC) injuries can be devastating for patients. They are heterogenous in nature making differentiation and reporting complex. Sporting injuries and Road Traffic Accidents (RTA) are the two most common mechanisms of injury (MOI). This study separated patients via MOI to assess for differences in pattern of injury or patient reported outcomes measures (PROM).

Methods

From a prospectively collected database of Multi-ligament knee injuries, patients with a confirmed PLC injury requiring surgery (grade III) were identified. Patients were excluded if they did not have PROM; IDKC, KOOS, Tegner, at a minimum of 12 months follow up, or complete surgical data. Patient demographics included MOI, age, sex, BMI. Surgical data included concurrent ligament injury to allow modified Schenk Knee Dislocation(KD) classification, common peroneal nerve injury (CPN), meniscal injury, timing of surgery and reconstruction technique used. Patients were separated into 3 cohorts based on MOI; Group A; injured via sports, Group B; RTA, group C; other. Student's t-tests were employed for continuous variables, chi-squared tests were utilized for categorical variables. Logistic regression was used to determine association between KD classification and CPN injury. All statistical tests were 2-sided, and p values <0.05 considered significant.

Results

67 patients were included (1992–2022). Mean age 32.9(SD 12.3), mean BMI; 27.7(6.92), and 86.7% male. MOI; 33 patients in Group A, 24 in Group B, 10 in Group C. Mean follow-up was 4.22(±0.18) years.
Modified Schenk classification, KDI(L); 35(52.2%), KD I(L)N; 5(7.5%), KD III(L); 11(16.4%), KD III(L)N; 4(6.0%), KD IV; 4(6.0%), KD V 5(7.5%), KD VN; 5(7.5%). The risk of nerve injury increased in patients with higher KD classification levels. (p <0.001). There were more nerve injuries in group A(30%) than group B(8%) and C(20%). There were also more meniscal injuries in Group A(42%), compared to group B(17%) and C(30%).
46(68.7%) patients had anatomic reconstruction (Arciero/La Prade), 7(10.4%) non-anatomic (Larson), 8(11.9%) underwent ligament repair, 5(7.5%) fibular head avulsion repair and 1(1.5%) isolated LCL reconstruction. There was no significant difference in technique across the groups. Group A was operated on faster compared to Group B (64.6 vs 255.9 days p=0.01) and Group C (112.3) but this was not significant (p=0.40).
PROM - Group A, 76.8(17.0), had significantly higher post-operative IDKC than group B,60.5 (21.2), p 0.002, and group C 55.7(12.6), p 0.003. Group A had significantly better KOOS scores in pain, daily living, sports, and quality of life compared to Group B, and significantly better pain, daily living, and sports scores compared to Group C. Post-operative Tegner score was significantly higher in Group A compared to Group B, 6.04(2.01) vs 4.55(1.85) p0.02 but not Group C 5.14 (1.77), p0.30.

Conclusion

Sporting injuries have a different pathogenesis to RTAs and are more likely to involve the CPN and menisci. Despite this, they have improved PROM. This is potentially related to patient factors, such as motivation and a desire to return to pre-injury level of activity. Future studies should seek to separate these two cohorts and assess if currently accepted principles of treatment apply equally to both.