Quality of Life and Functional Outcomes after Multiligament Knee Reconstruction

Abstract

Objectives: Although dislocation of the knee is rare, the high-energy nature of most injuries often results in high morbidity and sometimes limb-threatening injury. Literature regarding knee dislocations tends to focus upon management. There is a lack of research investigating quality of life for patients having undergone multi-ligament knee reconstruction. The purpose of our study was to review quality of life and functional outcomes as well as examine preoperative variables that may affect these outcomes for patients having undergone multi-ligament knee reconstruction. Methods: Retrospectively, we identified a total of 31 patients who underwent a standardized method of surgical reconstruction for multi-ligament knee injuries since 2006 at a single institution. A single surgeon performed all operations. A total of 28 knees (26 patients) were included in the final analysis. We contacted patients at a minimum of 12 months postoperatively (mean: 40.5 months; range: 12-111 months) and administered the Multi-ligament Quality of Life Questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests to examine the difference in quality of life and functional measures for the following factors: age (≤ 40 vs. > 40), sex, mechanism of injury, time to surgery ( 3 weeks), vascular injury, nerve injury, concomitant fracture, other injuries, Schenk classification for knee dislocation, manipulation, surgical release, previous knee ligament surgery, and subsequent revision. We then performed ageadjusted multivariable linear regression analysis, including factors that we found to be statistically significant in univariate analysis. A p-value of 0.05 was used for statistical significance and all analysis was performed using STATA (College Station, TX). Results: For ML-QOL, we found that patients who had undergone previous knee ligament surgery had significantly worse mean scores relative to patients who had not undergo previous knee ligament surgery (122.9 vs. 80.2; p = 0.001) (higher score indicates worse quality of life). All other differences in ML-QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. After stratifying patients by history of previous knee ligament surgery (7 vs. 21), we found that patients with Schenk classifications of III or IV had significantly worse mean ML-QOL scores relative to patients with Schenk classifications of I or II (91.3 vs. 62.1; p = 0.0152). Conclusion: To our knowledge, our study is the first to investigate both quality of life and functional outcome measures for patients undergoing multi-ligament reconstruction after knee dislocation. We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. Among patients with no history of knee ligament surgery, higher Schenk classification was ass...

The Functional Outcomes of Delayed Surgical Reconstruction in Nonsport-Induced Multiligament Knee Injuries: A Retrospective Cohort Study

“…study reported worse ML-QOL scores in patients undergoing early reconstruction than those operated with delay. 19 In our study, we had no case of early presentation, and all the reconstructions had been performed within an average of 17.31 months or 519 days after injury. A couple of studies have investigated the results of late surgical reconstruction in patients with MLKIs.…”

Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review

“…Of the 31 publications, 5 of these 4 , 5 , 8 , 48 , 52 did not report the timing from injury to surgical repair/reconstruction of the cruciate ligaments. Based on each study’s stated mean time to surgery, 10 studies ∥ reported outcomes for acute surgical intervention, 8 studies 1 , 3 , 14 , 26 , 30 , 34 – 36 reported outcomes for delayed surgical intervention, and 8 studies 16 , 32 , 38 , 39 , 41 , 53 , 57 , 58 included outcomes on both. According to sex distributions and male-to-female ratios, all but 2 studies 1 , 48 reported that men represented the majority in each cohort of patients.…”

Current Concepts Review: Common Peroneal Nerve Palsy After Knee Dislocations

“…The most common pattern of nerve injury after knee dislocation is a CPN palsy. Tibial nerve injuries are rare 9 but have substantial consequences of both nerve-based and tendon transfer–based reconstructive options.…”

“…Although operative reconstruction and rehabilitation lead to marked improvement in knee-specific measures of function, there is usually a lasting impact on quality of life. 9 The frequency of common peroneal nerve (CPN) injury after knee dislocation is estimated to occur in 25% of patients. 24 The functional deficits associated with CPN injury affect ambulation, with 35% of patients requiring use of an ankle-foot orthosis (AFO).…”