Multi-Ligament Knee Injuries Treated by Ligament Reconstructions: Can We Identify Prognostic Factors for Functional and Radiological Outcomes at 2 to 8 Years?

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Serval ID
serval:BIB_701CA9BC88E4
Type
PhD thesis: a PhD thesis.
Collection
Publications
Institution
Title
Multi-Ligament Knee Injuries Treated by Ligament Reconstructions: Can We Identify Prognostic Factors for Functional and Radiological Outcomes at 2 to 8 Years?
Author(s)
SCHNEEBELI Valentine
Director(s)
Martin Robin
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2024
Language
english
Abstract
Background: Multiligament reconstruction (MLR) has become the standard surgical approach for treating multiligament knee
injuries (MLKIs).
Purpose: To identify prognostic factors for patient-reported outcome measures, return to work (RTW), return to sports, and radio- graphic osteoarthritis (OA) (Kellgren-Lawrence grade 2:2) after MLR for MLKI.
Study Design: Case-control study; Level of evidence 3.
Methods: Included were 52 consecutive patients (age, 35.5 6 11 years; 75% men), with MLKI sustained between 2013 and 2019 and treated with MLR. At a mean follow-up of 3.8 6 1.6 years, patient-reported outcome measure scores—including the Inter- national Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), and the 12-Item Short-Form Health Survey—RTW, return to sports, and weight- bearing radiographs were obtained. A total of 20 determinants were hypothesized and tested by univariate logistic regression for binary variables or linear regression for continuous variables. Only factors identified as significant (P \ .10) were entered into a multivariate logistic regression model.
Results: The prevalence of injury severity according to the Schenck knee dislocation (KD) classification was as follows: KD I (44%), KD III (36%), KD IV (10%), and KD V (10%). Increased KD grades resulted in decreased IKDC (P = .002) and all 5 KOOS subscales (P ::; .007 for all) scores. Medial meniscectomy (23%) was associated with a worse ACL-RSI score (P =
.007) and RTW failure (odds ratio [OR], 36.8; P = .035). Peroneal nerve palsy (6%) was associated with a worse ACL-RSI score (P ::; .001). Radiographic OA was observed in 38%, with distribution predominantly patellofemoral (80%) and medial tibiofemoral (45%). Traumatic cartilage damage (Outerbridge grade .2 [37%]) was associated with secondary patellofemoral (OR, 10; P =
.012) and medial tibiofemoral (OR, 10; P = .019) OA. Anterior cruciate ligament reconstruction failure (7%) was a risk factor for medial tibiofemoral OA (OR, 25.8; P = .006).
Conclusion: Increased Schenck KD grade, permanent peroneal nerve palsy, and irreparable medial meniscus lesions were prog- nostic factors for worse functional outcomes 3.8 years after MLKI was treated with MLR. Traumatic cartilage damage and anterior cruciate ligament failure were associated with the development of early OA.
Keywords
functional outcomes, multiligament reconstruction, prognostic factors, radiologic outcomes
Create date
02/10/2024 11:06
Last modification date
02/12/2024 12:26
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