High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction

Abstract

The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% (n = 10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n = 40) presented a KL classification of ≥2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n = 7) also presented arthritis in the contralateral knee, in 53.2% (n = 33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio = 13.2 [p = 0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.

Anatomical repair and ligament bracing of Schenck III and IV knee joint dislocations leads to acceptable subjective and kinematic outcomes

“…However, the small group size is due to the rarity of the injury and the single-center study design. Therefore, because of the high relevance of this topic, larger, longer-term investigations of this surgical procedure are required, especially since nearly about 25% of patients with KD suffer from osteoarthritis in the long-term [ 13 , 31 , 45 ]. Despite these limitations, anatomical repair and ligament bracing can be evaluated as a promising option for the treatment of KD based on the results of our study.…”

The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review

“…Because no distinction could be made between TPFs with and without softtissue lesions, it remains unclear which group is at higher risk for developing OA. An analysis of delayed multiligament knee reconstruction showed OA in 64.5% of the cases and that in 53.2% of the cases progression was most likely due to the initial injury [41]. TPFs with ligamentous lesions have a similar outcome to knee dislocations when treated in an acute setting [40].…”

“…Injuries to the PLC are reported to be present in 16.0-28.0% of knee injuries and are frequently underdiagnosed [41][42][43]. They are overlooked particularly often in cases of PCL injuries, despite up to 70.0% of PCL injuries showing concomitant damage to the PLC [50,52].…”

Diagnosis and treatment strategies of the multiligament injured knee: a scoping review

“…Multiligament knee injuries (MLKIs) are defined as a tear of two or more of the major knee ligaments comprising the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posteromedial corner (PMC) (which includes the medial collateral ligament (MCL)) and posterolateral corner (PLC) (which includes the lateral collateral ligament, LCL) 1. Such injuries can have life-changing consequences, such as accelerated progression of post-traumatic osteoarthritis,2 3 an inability to return to work or sport4 and associated neurovascular injuries 5. Left untreated or inappropriately treated, the prognosis is poor, with persistent pain and instability, and patients undergoing repeated surgical interventions 6.…”