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

Autor: Alentorn-Geli E; Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA.; Fundación García-Cugat, Barcelona, Spain.; Artroscopia GC, S.L., Barcelona, Spain.; Mutualidad Catalana de Futbolistas, Federación Española de Fútbol, Barcelona, Spain., Lazarides AL; Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA., Utturkar GM; Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA.; Department of Biomedical Engineering, Duke University, Durham, NC, USA., Myers HS; Department of Physical Therapy, Duke University, Durham, NC, USA., Samuelsson K; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.; Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Choi JHJ; Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA., Stuart JJ; Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA., Moorman CT 3rd; Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA. T.Moorman@orthocarolina.com.; Deparment of Orthopaedic Surgery, OrthoCarolina, Atrium Health, 1915 Randolph Road, Charlotte, NC, 28207, USA. T.Moorman@orthocarolina.com.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2019 Feb; Vol. 27 (2), pp. 445-459. Date of Electronic Publication: 2018 Aug 06.
DOI: 10.1007/s00167-018-5053-9
Abstrakt: 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.
Databáze: MEDLINE
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