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Knee Surgery, Sports Traumatology, Arthroscopy

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01-02-2019 | Knee

Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries

Authors: Eduard Alentorn-Geli, Alexander L. Lazarides, Gangadhar M. Utturkar, Heather S. Myers, Kristian Samuelsson, J. H. James Choi, Joseph J. Stuart, Claude T. Moorman III

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2019

Abstract

Purpose

To investigate the influence of injury and treatment factors on clinical/functional outcomes in multiligament knee injuries (MLKI).

Methods

Thirty-nine consecutive patients with confirmed and surgically treated MLKI who met inclusion criteria were scheduled for a follow-up visit to obtain: SF-12 and subjective feeling of normalcy between the operated and healthy knee, and IKDC, active range of motion (ROM), and stability exam (Lachman test, posterior drawer, and dial test at 30°). A chart review was used to obtain data on injury and treatment factors.

Results

The postoperative mean (SD) outcomes were: IKDC score 62.7 (25.9), flexion–extension ROM 125° (29°), and percentage of normalcy 74% (20%). The postoperative normal/nearly normal stability exam was: Lachman test 36 (95%) patients, posterior drawer at 90° 38 (97%) patients, and dial test of 39 (100%) patients. There were 24 (61.5%) and 23 (59%) patients with complications and reoperations, respectively. The presence of bicruciate injuries was associated with worse Lachman (p = 0.03) and posterior drawer tests (p = 0.03). Presence of injury to meniscal structures was associated with worse Lachman test (p = 0.03), lower percentage of normalcy (p = 0.02) and extension lag (p = 0.04). Injury to cartilage structures was associated with worse IKDC scores (p = 0.04). IKDC was lower in cases of posterolateral corner reconstruction (p = 0.03) and use of allograft tendons for reconstruction (p = 0.02); ROM was lower in allograft reconstruction (p = 0.02) and need for meniscal repair (p = 0.01). Bicruciate reconstruction led to worst posterior drawer test (p = 0.006).

Conclusions

The outcomes of MLKI might be negatively influenced by bicruciate ligament, meniscal, and cartilage injuries; with regards to treatment characteristics, need for posterolateral corner or bicruciate ligament reconstruction, use of allografts, or need for meniscal repair may similarly diminish outcomes. While surgical treatment provides good overall function, ROM and stability, it rarely results in a “normal” knee and the chances of complications and reoperations are high.

Level of evidence

Cross-sectional comparative study, Level III

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Title: Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries
Authors: Eduard Alentorn-Geli
Alexander L. Lazarides
Gangadhar M. Utturkar
Heather S. Myers
Kristian Samuelsson
J. H. James Choi
Joseph J. Stuart
Claude T. Moorman III
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5053-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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