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.