Browsing by Author "Lozano, Beatriz"
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Publication Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients(2023) Sánchez, Enrique; Lozano, Beatriz; Zijl, Jacco; Wolterbeek, Nienke; Passarelli, Luis; Janson, Fabio; Verdonk, Peter; Vuylsteke, Kristien; Espregueira, Joao; Valente, Cristina; Figueroa, Francisco; Maestro, Antonio; Figueroa, David; Andrade, RenatoBackground: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. Hypothesis: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. Study design: Cohort study; Level of evidence, 3. Methods: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. Results: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. Conclusion: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.Publication Rethinking the Schenck Classification for Multiligament Knee Injuries: Evaluating Whether the Schenck KD Grade Is Associated With the Presence of Vascular or Neurological Injuries in a Multicenter Study With 144 Patients(2025) Sanchez, Enrique; Lozano, Beatriz; Andrade, Renato; Valente, Cristina; Espregueira, João; Figueroa, Francisco; Figueroa, David; Vuylsteke, Kristien; Verdonk, Peter; Passarelli , Luís Eduardo; Janson Angelini, Fabio; Zijl, Jacco; Wolterbeek, Nienke; Maestro, AntonioBackground: Posterolateral corner (PLC) lesions and knee dislocations (KDs) have been recognized as risk factors for vascular and neurological injuries in patients with multiligament knee injury (MLKI), but an association between Schenck KD grade and neurovascular lesions has yet to be established. Hypothesis: The ligamentous injury pattern in MLKIs with high KD grades will be associated with a higher likelihood of vascular and neurological injuries. Study design: Cross-sectional study; Level of evidence, 3. Methods: Included were 144 patients from a multicenter database with surgically treated MLKI. All patients were skeletally mature, had MLKI lesion identified on magnetic resonance imaging and confirmed intraoperatively, and did not have any previous knee surgery or previous vascular or neurological lesions. Demographic data (sex, age), injury mechanism (high energy, sports injury, low energy), ligaments injured, and neurological and vascular lesions were recorded. A new classification for MLKI based on ligamentous injury pattern, and intended for all MLKIs (with and without KD) was developed, and all patients were categorized according to this classification. Associations were evaluated between the risk of vascular and neurological lesion and demographic data, injury mechanism, and new classification grade. Results: The mean patient age was 33.9 years (range, 15-64 years), and 72% were male. High-energy trauma was the most common injury mechanism (55.6%). Vascular injury was present in 5 patients (3.5%) and nerve injury in 17 (11.8%), with 1 patient (0.7%) having both. None of the analyzed variables were associated with the presence of vascular lesion. Univariate logistic regression showed that medial collateral ligament (MCL) lesion decreased the probability of neurological injury (odds ratio [OR], 0.29; 95% CI, 0.1-0.87; P = .03) while PLC injury increased that probability (OR, 12.66; 95% CI, 1.63-100; P = .02). Multivariate logistic regression showed that the proposed MLKI grade was significantly associated with the presence of neurological lesions, with a 2.5-fold increase in the odds of having a neurological injury for each increase in grade (OR, 2.47; 95% CI, 1.36-4.50; P = .003). Conclusion: PLC injuries increased the odds of neurological injury in MLKI, while MCL injuries decreased these odds. MLKI grade and presence of PLC injury was associated with the presence of neurological injury. MLKI grade was not associated with the presence of a vascular lesion.