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Mussell EA, Crawford AE, Ithurburn MP, Layton BO, Fleisig GS, Rothermich MA, Emblom BA, Ryan MK, Dugas JR, Andrews JR, Cain EL. Outcomes of Surgical Treatment for Multiligament Knee Injuries in a Cohort Including Competitive Athletes With Long-Term Follow-Up. Orthop J Sports Med 2024; 12:23259671241266619. [PMID: 39247533 PMCID: PMC11375643 DOI: 10.1177/23259671241266619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 09/10/2024] Open
Abstract
Background There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature. Purpose To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period. Study Design Case series; Level of evidence, 4. Methods We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression. Results Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up. Conclusion Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.
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Affiliation(s)
- Eric A Mussell
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Anna E Crawford
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Matthew P Ithurburn
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Branum O Layton
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Marcus A Rothermich
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Michael K Ryan
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Prevea Health Orthopaedics and Sports Medicine, Green Bay, Wisconsin, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - James R Andrews
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
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Zhong J, Lee NJ, Crutchfield C, Mueller J, Ahmad C, Trofa D, Lynch TS. Perioperative outcomes in isolated versus multiligamentous anterior cruciate ligament reconstruction: a retrospective cohort analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1597-1607. [PMID: 38363347 DOI: 10.1007/s00590-024-03848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The outcomes of anterior cruciate ligament reconstruction in the setting of multiligamentous knee injury (M-ACLR) have not been well characterized compared to isolated ACLR (I-ACLR). This study aims to characterize and compare short-term outcomes between I-ACLR and M-ACLR. METHODS This is a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017. Current Procedural Terminology codes were used to identify and compare elective I- and M-ACLR patients, excluding patients undergoing concomitant meniscal or chondral procedures. Patient demographics and outcomes after I- and M-ACLR were compared using bivariate analysis. Multiple logistic regression analyzed if multiligamentous ACLR was an independent risk factor for adverse outcomes. RESULTS There was a total of 13,131 ACLR cases, of which 341 were multiligamentous cases. The modified fragility index-5 was higher in multiligamentous ACLR (p < 0.001). Multiligamentous ACLR had worse perioperative outcomes, with higher rate of all complications (3.8%, p = 0.013), operative time > 1.5 h (p < 0.001), length of stay (LOS) ≥ 1 day (p < 0.001), wound complication (2.1%, p = 0.001), and intra- or post-op transfusions (p < 0.001). In multiple logistic regression, multiligamentous ACLR was an independent risk factor for LOS ≥ 1 (odds ratio [OR] 5.8), and intra-/post-op transfusion (OR 215.1) and wound complications (OR 2.4). M-ACLR was not an independent risk factor for any complication, reoperation at 30 days, readmission, urinary tract infection (UTI), or venous thromboembolism (VTE). CONCLUSION M-ACLR generally had worse outcomes than I-ACLR, including longer LOS, need for perioperative transfusions, and wound complications.
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Affiliation(s)
- Jack Zhong
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA.
- Department of Orthopaedic Surgery, New York University Langone Health, New York, 10010, USA.
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Connor Crutchfield
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - John Mueller
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Christopher Ahmad
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - David Trofa
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - T S Lynch
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, 48202, USA
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Korber SS, Fathi A, Bolia IK, Panish BJ, Benvegnu N, Juhan TW, Weber AE, Argintar EH, Hatch GF. Outcomes of multiligament knee injury treated with versus without internal brace suture augmentation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:303-309. [PMID: 37490067 DOI: 10.1007/s00590-023-03575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE To compare the postoperative outcomes between Internal Brace (IB) and non-IB patients who underwent surgical management of multiple-ligament knee injuries (MLKI). METHODS Patients who underwent surgical management of MLKI at two institutions between 2010 and 2020 were identified and offered participation in the study via the collection of postoperative functional outcomes for MLKI; Lysholm Knee score, Multiligament Quality of Life (ML-QOL), Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT), Pain Interference (PI), Physical Function (PF), and Mobility instruments (MI). The postoperative outcomes and reoperation rates were compared between the IB group and non-IB group. RESULTS One hundred and twenty-six patients were analyzed; 89 were included in the IB group (31.5% female; age 35.6 ± 1.4 years), and 37 were included in the non-IB group (25.7% female; age 38.8 ± 2.4 years). Mean follow-up time of the entire cohort was 37.9 ± 4.7 months [IB: 21.8 + 1.63; non-IB: 76.4 ± 6.2, p < 0.001). The IB group achieved similar PROMIS CAT [PROMIS Pain (51.8 + 1.1 vs. 52.1 + 1.6, p = 0.8736), Physical Function (46.6 + 1.2 vs. 46.4 + 1.8, p = 0.9168), Mobility (46.0 + 1.0 vs. 43.7 + 1.6, p = 0.2185)], ML-QOL [ML-QOL Physical Impairment (36.6 + 2.5 vs. 43.5 ± 4.2, p = 0.1485), Emotional Impairment (42.5 + 2.9 vs. 48.6 ± 4.6, p = 0.2695), Activity Limitation (34.5 + 2.8 vs. 36.2 ± 4.3, p = 0.7384), Societal Involvement (39.1 + 3.0 vs. 41.7 + 4.2, p = 0.6434)] and Lysholm knee score (64.9 + 2.5 vs. 60.4 + 4.0, p = 0.3397) postoperatively compared the non-IB group, but the differences were not significant. CONCLUSION In this cohort of patients with MLKI treated with versus without IB, outcomes and reoperation rates trended toward favoring IB, but the study was not sufficiently powered to reach statistical significance. Internal bracing could be useful in the management of MLKI. In the future, matched patient cohorts with more patients are warranted to further evaluate the clinical impact of the internal brace in MLKI.
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Affiliation(s)
- Shane S Korber
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Amir Fathi
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Ioanna K Bolia
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Brian J Panish
- Orthopaedic Surgery, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - Neilen Benvegnu
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Tristan W Juhan
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA.
| | - Evan H Argintar
- Orthopaedic Surgery, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - George F Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
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Anatomical repair and ligament bracing of Schenck III and IV knee joint dislocations leads to acceptable subjective and kinematic outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:4188-4197. [PMID: 33688978 PMCID: PMC8595154 DOI: 10.1007/s00167-021-06501-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to analyze the outcomes of anatomical repair and ligament bracing for Schenck III and IV knee dislocation (KD). METHODS The results of 27 patients (15 and 12 cases of Schenck III and IV KD, respectively) after a mean follow-up of 18.1 ± 12.1 months (range 6-45 months) were retrospectively reviewed. Twenty-two patients suffered high-kinetic-energy accidents, whereas five patients suffered ultralow-velocity (ULV) trauma due to obesity. The outcome measures were the Lysholm score, Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form 36 (SF-36) score. A kinematic 3D gait analysis with five walking trials was performed to compare the patients and healthy controls. RESULTS The mean KSS, HSS score, Lysholm score, and KOOS were 77.4 ± 14.4, 84.6 ± 11.2, 81.5 ± 10.4, and 67.3 ± 16.8, respectively. No intra- or postoperative complications occurred. The mean range of motion deficiency compared to the healthy side was 24.4 ± 18.5°. Ten patients had first-degree residual laxity of the anterior cruciate ligament; 12 and 2 patients had first- and second-degree residual laxity of the collateral ligament, respectively. Five patients underwent additional arthroscopic arthrolysis due to arthrofibrosis at an average of 6.2 ± 1.9 months (range 4-9 months) after the initial surgery. The 3D gait analysis showed no major differences in joint stability or movement between the patients and healthy controls. Only the ULV trauma patients had significantly lower outcome scores and showed larger kinematic deviations in joint movement during the gait analysis. CONCLUSION Anatomical repair with ligament bracing is a suitable surgical procedure in the treatment of KD and provides evidence in clinical practice with the benefit of early, definitive repair and preservation of the native ligaments. Patients reach acceptable subjective and objective functional outcomes, including mainly normalized gait patterns during short-term follow-up, with only minor changes in kinematics and spatial-temporal characteristics. Obese patients who suffered ULV trauma showed significantly inferior outcomes with larger deviations in joint kinematics. LEVEL OF EVIDENCE Level III.
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