多发性膝关节损伤(MLKIs)代表了广泛的病理,具有潜在的破坏性后果。目前,在术语上存在分歧,这些损伤的诊断和治疗限制了临床护理和研究。本研究旨在就命名法达成共识,诊断,MLKI患者的治疗和康复策略,同时确定了进一步研究的重要研究重点。根据英国运动医学杂志指南,使用经过验证的Delphi方法进行了国际共识过程。由来自14个国家的39名成员组成的多学科小组,完成了三轮在线调查,探索术语的各个方面,诊断,治疗,康复和未来的研究重点。每个声明的协议级别(LoA)以5点Likert量表进行匿名评级,鼓励专家建议修改或补充声明。如果>75%的受访者同意且少于10%的受访者不同意,则最后一轮共识的LoA被定义为“先验”,记录和讨论了不同的观点。经过三轮德尔福,50项(92.6%)达成共识。在命名法中达成共识的关键陈述包括对MLKI的明确定义(LoA97.4%)以及需要更新的MLKI分类系统来对损伤机制进行分类。非韧带结构损伤的程度以及是否存在脱位。在诊断中,达成的共识是,对于高能背景下的MLKI和某些损伤模式,包括双核和PLC损伤,CT血管造影评估的阈值应该较低(LoA89.7%).应力射线照相或术中透视的值也达成共识(LoA89.7%)。在治疗中,人们普遍认为,现有文献普遍支持MLKI的手术管理,特别是对于年轻患者(LoA100%),并且应尽可能进行单阶段手术(LoA92.3%)。这一共识声明将促进MLKI的临床沟通,这些患者的护理和MLKI未来的研究。
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.