Surgically Treated Multiligamentous Knee Injuries With Lateral Collateral Ligament Disruption and Vascular Injury Show Higher Incidence of Peroneal Nerve Injury

Purpose: To clarify which specific ligamentous constellations predispose patients to peroneal nerve or vascular injuries in multiligament knee injuries (MLKIs).

Methods: This was a retrospective review of patients who underwent surgical treatment for MLKI, defined as surgically reconstruction or repair of at least 2 ligaments (anterior cruciate ligament [ACL], posterior cruciate ligament [PCL], medial collateral ligament [MCL], and/or lateral collateral ligament [LCL]) owing to identified injury and laxity between April 2008 and August 2024. Demographic data and clinical records were obtained, and injury patterns were categorized based on individual ligament involvement (ACL-MCL, ACL-LCL, PCL-MCL, PCL-LCL, ACL-PCL, ACL-PCL-MCL, ACL-PCL-LCL, and ACL-PCL-MCL-LCL). χ2 Analysis and binary logistic regression were performed to evaluate the association between ligament patterns and neurovascular injury risk, adjusting for age, sex, and body mass index (BMI).

Results: A total of 171 patients were included (mean age, 24 years), with 23% sustaining peroneal nerve injuries and 3% sustaining vascular injuries requiring surgical repair. Peroneal nerve injuries were significantly more common in MLKIs involving the ACL-LCL (41%) and ACL-LCL-PCL (53%) compared with other patterns. Binary logistic regression revealed that LCL involvement was associated with an 8-fold increase in peroneal nerve injury risk (odds ratio [OR], 8.042; P = .003); male sex (OR, 2.870; P = .032) and higher BMI (OR, 1.082; P = .008) were also significant predictors. Of 11 patients with vascular injuries, 6 (55%) sustained concurrent peroneal nerve injuries (OR, 6.34; 95% confidence interval, 1.64-24.48; P = .007). No significant predictors were found for vascular injury.

Conclusions: Among patients with MLKIs, involvement of the LCL confers an 8-fold higher risk of peroneal nerve injury, with additional risk factors including male sex and elevated BMI. Although no specific predictors were identified for lower-extremity vascular injuries, patients with such injuries were more likely to experience concomitant peroneal nerve injuries. These findings underscore the need for heightened clinical vigilance for peroneal nerve injuries in MLKIs involving the LCL or in the presence of vascular injuries.