Emery, Carolyn A.

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.

AbstractA “look‐up line” (LUL) has been proposed for ice hockey, which is an orange 1 m (40′) warning line (WL) painted on the ice at the base of the boards. The LUL purports to provide an early warning to players to keep their head up prior to and as they are being checked. We determined if players looked up more on a rink with the LUL compared to a traditional Control rink. Elite offensive (O) and defensive (D) players competed 1 vs. 1, while wearing an eye tracker that recorded their quiet eye (QE) and fixation and tracking (F‐T) and an electrogoniometer that measured head angle. External cameras recorded skate duration during four skate phases: P1 preparation, P2 decision‐making, P3 cut to boards, P4 contact. The QE was the final fixation prior to contact between O and D as they skated towards and across the WL during P3 and P4. Skate phase durations (%) did not differ by rink or rink by position. More QE and F‐T occurred on the WL on the LUL rink than on the Control. The expected increase in head angle on the LUL rink did not occur during P3 or P4. Post‐hoc results also showed O and D skated further from the boards on the LUL rink, suggesting the players preferred to control the puck on white ice, rather than the orange colour of the LUL rink. More research is needed to determine if these results apply to the competitive setting.