Single-Stage Surgical Treatment of Multi-ligament Knee Injuries Results in Lower Cost and Fewer Complications and Unplanned Reoperations Compared With Staged Treatment

Lau, Brian C.; Varsheya, Kunal; Morriss, Nicholas; Wickman, John R.; Kirkendall, Donald T.; Abrams, Geoffrey D.

doi:10.1016/j.asmr.2022.06.012

Cited by 9 publications

(9 citation statements)

References 25 publications

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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%

“…Also, the rate of postoperative stifness in patients who underwent surgery for MLKI was identiied to be 9.8% (95% CI 0.07-0.13) in this meta-analysis. Postoperative stifness is a common complication after MLKI surgery, with a reported rate between 4.5% and 28.9%, that adversely afects postoperative patient outcomes [5,13,21]. Timing of surgery has been implicated as a potential risk factor for postoperative stifness following MLKI in prior studies, but with some controversy.…”

Section: Discussionmentioning

confidence: 99%

“…It has been previously reported that MLKIs are more common in males and active young patients exposed to high‐energy trauma [4, 21]; however, MLKIs are also observed with lower energy injuries and in female and elderly patient populations [43]. In the literature, no significant relationship has been found between age, gender, and postoperative complications including stiffness after MLKI [4, 5, 32].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“… 31 More recently, a single-stage approach has been favored, since it has been demonstrated to result in fewer complications and costs. 32 This may be particularly beneficial for MLKI’s with PCL involvement, as it has been demonstrated that early reconstruction of the PCL (less than or equal to 12 weeks since onset of injury) can prevent the development chondral injuries. 33 Repair for MLKI has also recently demonstrated viability, especially in the setting of internal bracing, and offers specific advantages over the use of a graft such as preserving native tissues, reducing incidence of osteoarthritis, and minimizing recovery time.…”

Section: Discussionmentioning

confidence: 99%

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Fathi,

Thompson,

Bolia

et al. 2024

ORR

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Purpose To compare the patient-reported outcomes between patients with posterior cruciate ligament (PCL) reconstruction or repair alone versus PCL reconstruction or repair with internal bracing (IB) in the context of multi-ligament knee injuries (MLKI). Methods All patients who underwent surgical management of MLKI at two institutions between 2006 and 2020 were retrospectively identified and offered participation in the study. Patient reported outcomes were measured via three instruments: Lysholm Knee score, Multiligament Quality of Life (ML-QOL), and the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT). The postoperative outcomes and reoperation rates were compared between the internal bracing and non-internal bracing groups. Results Fifty-two patients were analyzed; 34 were included in the IB group (17.6% female; age 33.1 ±1.60 years), and 18 were included in the non-IB group (11.1% female; age 34.1 ±3.72 years). Mean follow-up time of the entire cohort was 1.44 ± 0.22 years (IB: 1.21 ± 0.18; non-IB: 2.1 ±0.65). There were no significant differences between PROMIS CAT [PROMIS Pain (54.4 ±1.78 vs 51.7 ±1.70, p=0.319), Physical Function (44.3 ±2.27 vs 47.9 ±1.52, p=0.294), Mobility (44.0 ±1.71 vs 46.1 ±2.10, p=0.463)], ML-QOL [ML-QOL Physical Impairment (40.7 ±4.21 vs 41.7±5.10, p=0.884), Emotional Impairment (49.2 ±4.88 vs 44.7±5.87, p=0.579), Activity Limitation (43.5 ±4.56 vs 31.5±3.62, p=0.087), Societal Involvement (44.9 ±4.96 vs 37.5 ±5.30, p=0.345)] and Lysholm knee score (61.8 ±4.55 vs 61.0 ±4.95, p=0.916) postoperatively compared to the non-IB group. Conclusion In this group of patients, function and patient-reported outcomes between patients treated with PCL reconstruction and repair without internal brace versus those with additional internal brace augmentation were not significantly different. Further research encompassing a larger patient sample is necessary to investigate the efficacy of the internal brace for PCL injury in the context of MLKI injuries.

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“… 16 Thus, the technique allowing the creation of the trans-septal portal without the need for a posterolateral portal has an added benefit in terms of safety. 4 , 14 , 17 It also enables establishing the trans-septal portal in cases when creation of posterolateral portal is risky or impossible.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Trans-septal Portal of the Knee With Direct Visualization and No Need for Posterolateral Portal Creation

Malinowski,

Kim,

Kennedy

et al. 2023

Arthroscopy Techniques

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Single-Stage Surgical Treatment of Multi-ligament Knee Injuries Results in Lower Cost and Fewer Complications and Unplanned Reoperations Compared With Staged Treatment

Cited by 9 publications

References 25 publications

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

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

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Arthroscopic Trans-septal Portal of the Knee With Direct Visualization and No Need for Posterolateral Portal Creation

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