Factors Associated with Knee Stiffness following Surgical Management of Multiligament Knee Injuries

Abstract

Postoperative knee stiffness can influence outcomes following operative treatment of multiligament knee injuries (MLKIs). The purpose of this study was to evaluate patient and surgical factors that may potentially contribute to stiffness following surgery for MLKIs. All surgically managed MLKIs involving two or more ligaments over a 10-year period at a single level one trauma center were included in this study. A retrospective review was performed to gather objective data related to the development of knee stiffness after surgery. Patients were classified as "stiff" postoperatively if they (1) had a flexion contracture greater than 10 degrees, (2) failed to reach 120 degrees of flexion at final follow-up, or (3) underwent a manipulation under anesthesia with or without arthroscopic lysis of adhesions to improve range of motion. Patient and surgical factors were evaluated systematically to determine factors associated with stiffness. The mean age of the cohort was 27.6 years at the time of surgery and mean follow-up was 50 weeks. Overall, 26/121 (21.5%) knees were diagnosed with postoperative stiffness. In the acute postoperative phase, 17 patients underwent manipulation under anesthesia. There were no significant differences in age, body mass index, associated injuries, mechanism, external fixation use or surgical timing (acute vs. chronic) between stiff and normal knees. Factors associated with the development of postoperative stiffness included knee dislocation ( = 0.04) and surgical intervention on three or more ligaments ( = 0.04). Careful attention to postoperative rehabilitation regimens should be given to patients with knee dislocations and/or those undergoing reconstruction or repair of three or more injured ligaments. Surgeons may utilize spanning external fixation if necessary without increasing the rate of long-term stiffness. Further, acute surgery does not appear to influence rates of postoperative stiffness or the need for manipulation.

Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

“…Henley et al. evaluated patient and surgical factors that may potentially contribute to joint contracture following surgery [ 14 ]. Based on their results, no significant differences were observed in age, body mass index, associated injuries, or surgical timing.…”

“…Early surgical treatment has been advocated to improve results [ 9 – 11 ], and the critical time to reestablish anatomic relationships is the first 3 weeks after injury [ 12 ]. Acute ligament reconstruction improves postoperative knee stability [ 13 ] and may increase the rate of arthrofibrosis, which causes deterioration in knee function and requires additional surgeries [ 14 ].On the contrary, delayed reconstruction may provide the time for natural healing of extraarticular ligaments and decrease postoperative arthrofibrosis [ 5 , 15 , 16 ]; it requires multiple grafts and tunnels for reconstructions, resulting in donor-site morbidity and risk of tunnel convergence [ 17 ]. Staged surgery, which involves repair of the extraarticular ligaments in the acute stage and subsequent reconstruction of the cruciate ligaments at a later stage, showed excellent clinical results [ 18 ].…”

Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury

“…In addition, primary repair might fasten rehabilitation and reduce long-term OA. 12 , 13 , 14 Van der List and DiFelice 12 compared ACL repair with reconstruction, reporting greater ROM up to 3 months postoperatively and earlier return to full ROM. Murray and Fleming 14 performed a preclinical study on Yucatan mini-pigs and noted significantly less OA after primary repair, and biomechanical properties of repaired ligaments were equally as good as grafts.…”

Forecast Criteria for Forensic Medical Assessment of the Severity of Injuries in Subcutaneous Fractures of the Lower Limb Bones

“…Наявність таких факторі ризику, як багатоуламкові переломи діафізу, і особливо епіметафізу, є цілком очікуваною, тому що результатом високоенергетичної травми є не тільки кісткове ушкодження, а й значне травмування м'яких тканин та судин [17,18], що призводить до уповільнення початкових стадій репаративної регенерації [19]. Частим наслідком епіметафізарних внутрішньосуглобових переломів є ригідні контрактури суглобів [20,21]. Наявність значної кількості кісткових фрагментів є фактором, який негативно впливає на нормальний процес загоєння перелому [22], так як потребує продукування значної кількості кісткової тканини.…”