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.

中文翻译：

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膝关节多韧带损伤 （MLKI）：关于命名、诊断、治疗和康复的专家共识声明


膝关节多韧带损伤 （MLKI） 代表了广泛的病理学，具有潜在的破坏性后果。目前，这些损伤的术语、诊断和治疗方面的分歧限制了临床护理和研究。本研究旨在就 MLKI 患者的命名、诊断、治疗和康复策略达成共识，同时确定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。一个由来自 39 个国家/地区的 14 名成员组成的多学科小组完成了 3 轮在线调查，探讨了命名、诊断、治疗、康复和未来研究重点的各个方面。对每项陈述的同意水平 （LoA） 采用 5 分李克特量表进行匿名评分，鼓励专家提出修改或补充陈述的建议。如果 >75% 的受访者同意且不到 10% 的受访者不同意，并且记录和讨论不同意见，则最后一轮共识的 LoA 被定义为“先验”。经过三轮 Delphi 轮次，50 个项目 （92.6%） 达成共识。在命名法中达成共识的关键陈述包括 MLKI 的明确定义 （LoA 97.4%） 以及需要更新的 MLKI 分类系统，该系统对损伤机制、受伤非韧带结构的范围以及是否存在脱位进行分类。在诊断中，达成共识，在高能量背景下使用 CT 血管造影评估 MLKI 和某些损伤模式（包括双十字损伤和 PLC 损伤）应有一个较低的阈值 （LoA 89.7%）。 应力 X 线照相或术中透视的价值也达成共识 （LoA 89.7%）。在治疗方面，人们普遍认为现有文献通常支持对 MLKI 进行手术治疗，特别是对于年轻患者 （LoA 100%），并且应尽可能进行单期手术 （LoA 92.3%）。该共识声明将促进 MLKI 的临床交流、这些患者的护理以及 MLKI 内的未来研究。