Early surgery and number of injured ligaments are associated with postoperative stiffness following multi‐ligament knee injury surgery: a systematic review and meta‐analysis

Özbek, Emre Anıl; Dadoo, Sahil; Grandberg, Camila; Runer, Armin; Cong, Ting; Hughes, Jonathan D.; Irrgang, James J.; Musahl, Volker

doi:10.1007/s00167-023-07514-9

Cited by 8 publications

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References 69 publications

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“…However, an even more contentious issue is the potential to mitigate joint degradation by ACL reconstruction, as there are conflicting findings regarding the optimal strategy for preventing knee OA [ 4 , 26 , 31 , 32 , 42 , 44 , 45 , 46 ].…”

Section: Introductionmentioning

confidence: 99%

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature

D'Ambrosi,

Carrozzo,

Meena

et al. 2024

J. exp. orthop.

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PurposeThe aim of the present systematic review was to quantitatively synthesize the best literature evidence regarding osteoarthritis developing after anterior cruciate ligament reconstruction (ACLR), including only studies with a follow‐up duration of at least 20 years.Material and MethodsA systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines on four electronic databases (PubMed, Scopus, EMBASE and Cochrane Library). The outcome measures extracted from the studies were failure rate, subsequent knee surgery on the same knee, radiographic development of osteoarthritis measured with Kellgren–Lawrence, International Knee Documentation Committee (IKDC) radiographic score and Ahlbäck classification. The health of both the ACLR knee and the contralateral knee was compared.ResultsA total of 1552 patients were included in the study, of which 1290 (83.11%) were operated on using a patellar tendon graft, 190 (12.24%) with hamstrings, 27 (1.73%) with an iliotibial band and 45 (2.89%) with patellar tendon plus a ligament augmentation device (LAD). The mean age at the time of surgery was 25.18 ± 1.91 years, and the mean follow‐up time was 23.34 ± 2.56 years. Analysing IDKC Score at final follow‐up, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 33.2% (324/976) of the patients showed a moderate to severe degree (Grade C or D) of osteoarthritis, while for Kellgren–Lawrence, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 28.9% (196/678) of the patients showed a moderate to severe degree (Grade III or IV) of osteoarthritis. In total, 1552 patients were registered, 155 reruptures (9.98%) and a total of 300 (19.3%) new surgeries, of which 228 meniscectomy (14.69%), 21 (1.35%) knee arthroplasty and 17 (1.09%) hardware removal were recorded.ConclusionsACL reconstruction appears to result in mild osteoarthritis in the long term in most of the patients and only less than 33.2% develop a moderate to severe degree of knee OA according to IKDC radiographic score. A slight degree of osteoarthritis appears to be present in ACLR knees compared with contralateral healthy knees.Level of EvidenceLevel IV.

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Section: Introductionmentioning

confidence: 99%

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature

D'Ambrosi,

Carrozzo,

Meena

et al. 2024

J. exp. orthop.

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A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

Minator Sajjadi,

Mirahmadi,

Alizad

et al. 2024

J. exp. orthop.

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PurposeMultiligament knee injuries (MLKIs) involve various ligaments in the knee. Current double‐bundle anatomical reconstructions of the medial collateral ligament (MCL) increase the level of technical complexity, often resulting in the establishment of numerous bone tunnels and different fixation points with additional hardware. To overcome these limitations, we proposed a novel minimally invasive nonanatomical MCL reconstruction with one tibial tunnel in the metaphysis using Achilles allograft in the MLKI setting.MethodsIn a retrospective study, we enroled 24 patients with MLKIs who underwent a new single‐strand short isometric construct (SIC) nonanatomical MCL reconstruction during 2020 and 2021. We fixed an Achilles allograft in one tunnel in the distal femur on the medial epicondyle and one tunnel in the metaphyseal part of the tibia using interference screws at 2 cm below the joint line between the anatomical insertion of the superficial MCL and the posterior oblique ligament. The patients underwent clinical and radiological assessment at the last follow‐up, 1–2 years after the operation, including valgus stress radiographs, range of motion (ROM), Lysholm and International Knee Documentation Committee (IKDC) scores.ResultsThe mean postoperative IKDC score was 77.8 (range, 50.1–86.6). The mean Lysholm score was 84.1 ± 11.9 (range, 96–59). The medial knee widening difference (i.e., mean side‐to‐side difference under valgus stress x‐ray) was measured to be 1.2 mm on average. Only two patients (8%) had ROM limitation of 20° in knee flexion, one of which had surgery failure. Results showed a significant statistical difference between the patients' outcomes according to the number of involved ligaments.ConclusionsThis novel SIC‐like technique with a single tibial metaphyseal tunnel demonstrated satisfactory patient‐reported outcome measures, valgus stress radiographs, ROM and a low rate of knee stiffness and graft failure. While the number of injured ligaments in MLKI patients significantly influenced the outcomes, the results remained acceptable across all patients.Level of EvidenceLevel IV.

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Outcomes after multiligament knee injury worsen over time: A systematic review and meta‐analysis

Klasan,

Maerz,

Putnis

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeMultiligament knee injuries (MLKIs) are devastating injuries that can have life‐long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow‐up.MethodsFour databases were queried for surgical outcome‐based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2‐year follow‐up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow‐up period, anatomical region and posterior‐cruciate ligament (PCL)‐based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random‐effects model analysis was performed.ResultsAfter the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow‐up was 4.06 years (range 2–12.7). The mean Lysholm score at 2‐year follow‐up was 86.09 [95% confidence interval [CI]: 82.90–89.28], with a yearly decrease of −0.80 [95% CI: −1.47 −0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56–86.14], with a yearly decrease of −1.99 [95% CI: −3.14 −0.84] (p < 0.001). Non‐PCL‐based injuries had a higher IKDC 83.69 [75.55–91.82] vs. 75.00 [70.75–79.26] (p = 0.03) and Lysholm score 90.84 [87.10–94.58] versus 84.35 [82.18–86.52] (p < 0.01) than PCL‐based injuries, respectively.ConclusionAccording to the present systematic review and meta‐analysis of MLKIs with minimum 2‐year follow‐ups, the patients who suffered an MLKI can expect to retain around 80‐85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL‐based injuries at 2 years postoperative.Level of EvidenceLevel IV meta‐analysis.

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Early surgery and number of injured ligaments are associated with postoperative stiffness following multi‐ligament knee injury surgery: a systematic review and meta‐analysis

Cited by 8 publications

References 69 publications

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature

A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

Outcomes after multiligament knee injury worsen over time: A systematic review and meta‐analysis

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