Long term outcome of early single stage surgery in multi-ligamentous injuries of knee

Goyal, Ankit; Kumar, Sanjay; Mishra, Pallav; Mehta, Nitin; Joshi, Deepak; Sinha, S.M.

doi:10.1016/j.jcot.2020.05.018

Cited by 5 publications

(3 citation statements)

References 35 publications

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“…The results support our original hypothesis; however, the 9.0% rate in the current study was lower than rates previously reported in smaller, single-center studies. In previous studies, the incidence of radiographic OA ranged between 44% and 53% at 2 to 3 years after MLKI 8,11 and between 42% and 69.2% between 8 and 10 years after surgery. 10,25 One important distinction between the current results and the previous studies was that we evaluated the diagnosis of OA, whereas other groups assessed radiographic changes after MLKI reconstruction.…”

Section: Discussionmentioning

confidence: 87%

“…3,5,14,15,27 To date, the incidence of posttraumatic OA for those who have experienced multiligament knee injury (MLKI) has been reported only in relatively small, single-center studies. 8,10,11,25 biomechanical changes secondary to the injury. 1,4 Both the inflammatory response and the postoperative biomechanical changes that may contribute to posttraumatic OA progression may be magnified after MLKI reconstruction when compared with ACL reconstruction; however, the incidence of OA has not been directly compared after ACL and MLKI reconstructions.…”

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confidence: 99%

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Leveraging Insurance Claims Data to Identify Risk Factors for Posttraumatic Osteoarthritis After Multiligament Knee Reconstruction

et al. 2023

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Background: The incidence of subsequent posttraumatic osteoarthritis (OA) diagnosis after surgery and the associated risk factors have been well reported after single-ligament anterior cruciate ligament (ACL) reconstruction; however, to date, the incidence of posttraumatic OA for those who have experienced multiligament knee injury (MLKI) has been reported only in relatively small, single-center studies. Purpose: To compare the incidence of OA diagnoses between patients with ACL injury versus patients with MLKI and to identify risk factors for OA diagnosis after MLKI. Study Design: Cohort study; Level of evidence, 3. Methods: This study used the PearlDiver Mariner database, which contains insurance claims information on >151 million orthopaedic patients. We identified 2 cohorts for this study by using Current Procedural Terminology codes. The cohorts included patients between the ages of 16 and 60 who underwent either isolated ACL reconstruction (n = 114,282) or MLKI reconstruction (n = 3325) between July 1, 2010, and August 30, 2016. MLKI reconstruction was operationally defined as ACL reconstruction plus concurrent surgical treatment of ≥1 additional ligaments. Demographic factors, concomitant meniscal and cartilage procedures, and subsequent reoperation to restore motion were recorded, as was the incidence of knee OA diagnosis within 5 years of the index surgical procedure. OA incidence and demographic and surgical factors were compared (1) between ACL and MLKI groups and (2) between patients with MLKI either with or without OA diagnosis. Results: A significantly greater proportion of patients with MLKI were diagnosed with knee OA within 5 years of surgery (MLKI = 299/3325 [9.0%] vs ACL = 6955/114,282 [6.1%]; P < .0001) (odds ratio [OR], 1.52; 95% CI, 1.35-1.72; P < .001). Factors associated with increased odds of OA diagnosis after MLKI included age ≥30 years (OR, 5.90), reoperation to restore motion (OR, 2.54), obesity (OR, 1.96), mood disorder diagnoses (OR, 1.85), partial meniscectomy (OR, 1.85), and tobacco use (OR, 1.72). Concomitant meniscal repair was protective against OA diagnosis (OR, 0.06). Conclusion: OA incidence was greater after MLKI reconstruction than after isolated ACL reconstruction. Potentially modifiable risk factors for OA after MLKI were identified and include obesity, tobacco use, depression, and the need for motion-restoring surgery.

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Section: Discussionmentioning

confidence: 87%

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confidence: 99%

Leveraging Insurance Claims Data to Identify Risk Factors for Posttraumatic Osteoarthritis After Multiligament Knee Reconstruction

et al. 2023

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“…As a result of the database searches, 1285 potentially eligible studies were identified, of which 89 duplicate studies were detected. After duplicate studies removed, 1,196 studies were scanned using titles and abstracts, 72 studies were included in the full‐text review to evaluate if they met the inclusion criteria, and 36 studies ultimately found to meet study eligibility criteria and were included in the systematic review and meta‐analysis [1, 2, 4–17, 19–23, 26, 29, 32–36, 41–44, 46, 47, 49, 50] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

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

Dadoo

Grandberg

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To perform a systematic review and meta‐analysis to investigate the rate of stiffness after multi‐ligament knee injury (MLKI) surgery and identify potential risk factors associated with postoperative stiffness. Methods This study was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) statement. Registration was done on the PROSPERO International Prospective Register of Systematic Reviews (CRD42022321849). A literature search of PubMed, Ovid, Embase, and Cochrane Library databases was conducted in October 2022 for clinical studies reporting postoperative stiffness after MLKI surgery. A quality assessment was performed using the Methodological Index of Non‐Randomized Studies (MINORS) grading system. The following variables were extracted from studies for correlation to postoperative stiffness: study characteristics, cohort demographics, Schenk classification, neurovascular injury, mechanism of injury, external fixator placement, timing of surgery, and concomitant knee injuries. Results Thirty‐six studies comprising 4,159 patients who underwent MLKI surgery met the inclusion criteria, including two Level‐II, fourteen Level‐III, and twenty Level‐IV studies. The average MINOR score of the studies was 14. The stiffness rate after MLKI was found to be 9.8% (95% CI 0.07–0.13; p < 0.01; I2 = 87%), and the risk of postoperative stiffness was significantly lower for patients with two ligaments injured compared to patients with ≥ 3 ligaments injured (OR = 0.45, 95% CI (0.26–0.79), p = 0.005; I2 = 0%). The results of the pooled analysis showed early surgery (< 3 weeks) resulted in significantly increased odds of postoperative stiffness compared with delayed surgery (≥ 3 weeks) (OR = 2.18; 95% CI 1.11–4.25; p = 0.02; I2 = 0%). However, age, gender, body mass index, energy of injury, and neurovascular injury were not associated with an increased risk of postoperative stiffness (n.s.). Conclusion Performing surgery within the first 3 weeks following MLKI, or concomitant injury of ≥ 3 ligaments, are significantly associated with increased risk of postoperative stiffness. These findings can be utilized by surgeons to decide the timing of surgery for MLKI surgeries especially in which ≥ 3 ligaments are injured. Level of evidence Level IV.

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Outcomes of multiligament knee injury treated with versus without internal brace suture augmentation

Korber,

Fathi,

Bolia

et al. 2023

Eur J Orthop Surg Traumatol

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Long term outcome of early single stage surgery in multi-ligamentous injuries of knee

Cited by 5 publications

References 35 publications

Leveraging Insurance Claims Data to Identify Risk Factors for Posttraumatic Osteoarthritis After Multiligament Knee Reconstruction

Leveraging Insurance Claims Data to Identify Risk Factors for Posttraumatic Osteoarthritis After Multiligament Knee Reconstruction

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

Outcomes of multiligament knee injury treated with versus without internal brace suture augmentation

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