Appendix Table A1.
Characteristics of the Included Studies (N = 50) a
| Study (Year) | Definitions | Study Period | Sample Size | KD I Injury, n (%) | MINORS Score b | ||
|---|---|---|---|---|---|---|---|
| MLKI | Knee Dislocation | Schenck KD | |||||
| Allen 2 (2015) | Grade 3 injury in ≥2 ligaments | NR | NR | 2007-2010 | 42 | 15 (35.7) | 17/24 |
| Atinga 3 (2022) | Acute injury involving ≥2 ligaments, or intra-articular fracture and injury of ≥1 ligament in patients with clinically suspected KD | NR | Single cruciate ligament injury | 2005-2018 | 115 | 1 (0.9) | 16/24 |
| Azar 4 (2011) | NR | NR | NR | 6-y period | 17 | 1 (5.9) | 11/16 |
| Bagherifard 5 (2019) | Tear of ≥2 of the 4 major knee ligaments (ACL, PCL, MCL, PLC [including LCL]) | NR | Injury of single cruciate ligament (ACL or PCL) | 2011-2016 | 41 | 15 (36.6) | 11/24 |
| Barrett 6 (2018) | NR | NR | NR | 2008-2015 | 32 | 16 (50.0) | 14/16 |
| Bi 7 (2022) | Involvement of ≥2 ligaments: ACL, PCL, MCL, LCL/PCL | TF dislocation at time of injury | NR | 2001-2020 | 190 | 73 (38.4) | 21/24 |
| Billieres 8 (2020) | Disruption of ≥2 of the 4 major ligaments | NR | Single cruciate ligament injury with 1 collateral ligament injury | 2013-2015 | 20 | 6 (30.0) | 13/16 |
| Born 9 (2014) | Disruption of ≥1 of the cruciate ligaments and ≥1 of the collateral ligaments through a documented or presumed KD event based on imaging, history, and pattern | NR | Single cruciate + collateral injury | 1992-2013 | 134 | 52 (38.8) | 16/24 |
| Borque 10 (2022) | ≥2 ligaments injured | NR | NR | 2001-2019 | 136 | 117 (86.0) | 13/24 |
| Djebara 12 (2022) | NR | NR | Single cruciate ligament injury | 2008-2013 | 29 | 12 (41.4) | 13/24 |
| Figueroa 13 (2021) | NR | Dislocated knee clinically or in plain radiograph with either ACL or PCL torn, with MCL or PLC complex tear | NR | NR | 1 | 1 (100.0) | 6/16 |
| Freychet 14 (2020) | NR | NR | NR | 1992-2015 | 40 | 6 (15.0) | 18/24 |
| Green 16 (2023) | Complete tear of ≥2 of the following: ACL, PCL, sMCL, LCL | Complete disruption of the normal TF articulation with radiographic evidence | Complete tearing of only a single cruciate ligament and clinical and/or radiological evidence of TF dislocation | 2001-2022 | 12 | 12 (100.0) | 8/16 |
| Hart 17 (2009) | NR | TF dislocation | Injury to 1 or both cruciate ligaments | 2002-2005 | 27 | 10 (37.0) | 17/24 |
| Hatch 18 (2018) | NR | NR | NR | 2006-2013 | 33 | 11 (33.3) | 14/24 |
| Hoit 20 (2021) | NR | NR | NR | 2011-2018 | 36 | 5 (13.9) | 22/24 |
| Hughes 21 (2022) | NR | NR | NR | 2009-2018 | 136 | 83 (61.0) | 11/24 |
| Kahan 23 (2021) | Injury to ≥2 of the following: ACL, PCL, MCL, LCL | Disruption on imaging of normal alignment of TF articulation | PCL- or ACL-intact KD with variable collateral involvement | 2001-2020 | 23 | 19 (82.6) | 16/24 |
| Kilicoglu 24 (2021) | NR | Complete loss of TF joint contact verified by radiography or multiligament injury with gross knee instability confirmed on MRI and clinically by orthopaedic surgeon | NR | 1997-2013 | 42 | 6 (14.3) | 12/24 |
| Kosy 26 (2018) | NR | NR | Single cruciate with collateral ligament injury | 2004-2016 | 188 | 27 (14.4) | 9/24 |
| Krych 28 (2014) | NR | NR | NR | 1992-2013 | 27 | 4 (14.8) | 18/24 |
| Krych 29 (2015) | NR | Ligamentous reconstruction for either a PCL-based multiligament injury or a minimum of 3 surgically treated ligaments | NR | 1993-2010 | 122 | 25 (20.5) | 11/24 |
| Labarre 30 (2023) | Disruption of ≥2 of the 4 ligaments, including >1 cruciate ligament | NR | NR | 2010-2020 | 235 | 99 (42.1) | 15/24 |
| Lee 31 (2022) | NR | NR | ACL or PCL injured | 2015-2018 | 42 | 16 (38.1) | 10/16 |
| Levy 33 (2015) | NR | Injury to multiple ligaments of the knee | NR | 1992-2013 | 125 | 29 (23.2) | 10/24 |
| Li 34 (2022) | Complete tear in ≥2 cruciate and/or collateral ligaments, with or without injuries of meniscus, nerves, arteries, or periarticular fractures | NR | 2 ligaments ruptured, 1 cruciate ligament and 1 collateral ligament, ACL/PCL + MCL/LCL/PCL | 2012-2020 | 97 | 29 (29.9) | 10/24 |
| Lian 35 (2020) | ≥2 ligaments injured | NR | NR | 2011-2018 | 108 | 57 (52.8) | 10/24 |
| Markus 36 (2022) | Injury to ≥2 of the 4 major ligaments: ACL, PCL, MCL, LCL | NR | NR | 2001-2021 | 221 | 101 (45.7) | 9/16 |
| Marwan 37 (2018) | NR | NR | MLI with involvement of just 1 of the cruciate ligaments | 2008-2016 | 49 | 5 (10.2) | 10/16 |
| Maxwell 38 (2021) | Grade 2 or 3 injury to ≥2 ligaments | NR | NR | 2011-2015 | 287 | 121 (42.2) | 8/24 |
| Mojica 41 (2023) | Injury to ≥2 of the 4 major ligaments: ACL, PCL, MCL, LCL/PLC | Recorded if TF dislocation was documented on initial radiographs or a documented reduction occurred in the emergency room | NR | 2011-2020 | 24 | 7 (29.2) | 16/24 |
| Mygind-Klavsen 43 (2017) | NR | NR | ACL or PCL injured | 2002-2010 | 196 | 57 (29.1) | 12/24 |
| Neri 44 (2019) | Complete injury to a combination of ≥2 of the 4 major ligaments (ACL, PCL, MCL, PLC) | NR | 1 cruciate ligament tear combined with a complete medial or lateral side injury | 1986-2017 | 256 | 144 (56.3) | 17/24 |
| Nicandri 45 (2010) | NR | Knee that presented dislocated and required reduction, or a grossly unstable knee with MRI documented bicruciate, 3-, or 4-ligament injury | Dislocations associated with multiligament injuries that did not include both cruciate ligaments | 2004-2005 | 35 | 2 (5.7) | 9/24 |
| Nielsen 46 (2022) | NR | NR | Tear of single cruciate ligament and either 1 or both collateral ligaments | 2005-2017 | 1160 | 903 (77.8) | 14/24 |
| Otto 47 (2020) | NR | Combined rupture of multiple ligaments leading to loss of the continuity of TF articulation | NR | 2014-2016 | 14 | 6 (42.9) | 11/24 |
| Patel 48 (2021) | ≥2 of the 4 major ligaments disrupted | NR | Involvement of ACL or PCL | 2011-2018 | 108 | 56 (51.9) | 14/24 |
| Poploski 49 (2023) | Assigned on the basis of all ligaments that had a grade 3 (complete) tear or were clinically incompetent and required surgical repair/reconstruction | NR | All injuries involving a single cruciate ligament and the medial and/or lateral side | 2011-2015 | 773 | 483 (62.5) | 8/24 |
| Sanders 50 (2017) | ≥2 ligaments injured | NR | NR | 1992-2004 | 48 | 9 (18.8) | 17/24 |
| Sanders 51 (2018) | ≥2 ligaments injured | NR | NR | 2006-2013 | 61 | 25 (41.0) | 11/24 |
| Scheu 53 (2020) | NR | NR | Injury to a single cruciate ligament. IA = ACL injured, PCL, LCL, MCL intact; IP = PCL injured, ACL, LCL, MCL intact | 2012-2017 | 50 | 9 (18.0) | 10/24 |
| Schlumberger 54 (2020) | NR | NR | Rupture of PCL and PCL/LCL or MCL | 2004-2019 | 1000 | 366 (36.6) | 9/24 |
| Shamrock 55 (2022) | Disruption of ≥2 of the 4 major ligaments | NR | NR | 2003-2018 | 207 | 125 (60.4) | 9/16 |
| Stannard 57 (2004) | NR | Dislocated or grossly unstable knee with tears of at least both ACL and PCL, documented on MRI with surgical confirmation | Dislocations associated with multiligamentous injuries that did not include both cruciate ligaments | 1996-2002 | 134 | 3 (2.2) | 13/24 |
| Tardy 58 (2017) | NR | All ligament injuries that involved ≥2 major ligaments | Injury to 1 cruciate ligament and associated collateral ligament injury | 2003-2011 | 39 | 18 (46.2) | 17/24 |
| Werner 61 (2014) | Disruption of ≥2 primary ligaments | NR | NR | 2001-2013 | 238 | 126 (52.9) | 18/16 |
| Woodmass 62 (2018) | ≥2 ligaments injured | NR | MLKI involving ACL or PCL | 2004-2013 | 23 | 7 (30.4) | 12/16 |
| Woodmass 63 (2018) | NR | NR | NR | NR | 20 | 6 (30.0) | 10/16 |
| Worley 64 (2019) | ≥2 ligaments injured | NR | NR | 12-y period | 357 | 58 (16.2) | 19/24 |
| Worley 65 (2022) | ≥2 ligaments injured | NR | NR | 12-y period | 231 | 32 (13.9) | 16/16 |
a
ACL, anterior cruciate ligament; IA, Schenck KD Subclass IA (knee dislocation with isolated ACL injury); IP, Schenck KD Subclass IP (knee dislocation with isolated PCL injury); KD, knee dislocation; LCL, lateral collateral ligament; MCL, medial collateral ligament; MINORS, methodological index for nonrandomized studies; MLI, multiligament injury; MLKI, multiligament knee injury; MRI, magnetic resonance imaging; NR, not reported; PCL, posterior cruciate ligament; PLC, posterolateral corner; sMCL, superficial medial collateral ligament; TF, tibiofemoral.
b
For noncomparative studies (maximum score = 16), a score of 0 to 5 indicates very low quality, a score of 6 to 9 indicates low quality, a score of 10 to 13 indicates fair quality, and a score of 14 to 16 indicates good quality. For comparative studies (maximum score = 24), a score of 0 to 12 indicates poor quality, a score of 13 to 18 indicates fair quality, and a score of 19 to 24 indicates excellent quality.