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Concomitant periarticular fractures predict worse patient-reported outcomes in multiligament knee injuries: a matched
Ajay C Kanakamedala1, Andrew J Sheean2, Michael J Alaia1
1Department of Orthopedic Surgery, NYU Langone Medical Center, 301 E 17th St, New York, NY, 10003, USA.
Aim:
There is a shortage of high-level evidence regarding periarticular fractures affect outcomes after MLKIs. The purpose of this study was to determine whether concomitant periarticular fractures with mutliligament knee injuries (MLKIs) predict worse patient-reported outcomes (PROMs) when compared to MLKIs without concomitant periarticular fractures after surgical repair and/or reconstruction.
Materials And Methods:
Medical records of patients who sustained MLKIs from January 1, 2009 to June 1, 2014 were retrospectively reviewed. All patients aged 18-65 years with grade III injuries of two or more knee ligaments and 1-year minimum follow-up were included. Patients with injuries or surgeries to either knee before their MLKIs were excluded. Radiographs and computed tomography imaging obtained at the time of injury were used to detect concomitant periarticular fractures. Patients with and without concomitant periarticular fractures were matched on a 1:2 basis, respectively. Multiple PROMs were collected, including the IKDC Subjective Knee Form (IKDC-SKF), and Knee Injury and Osteoarthritis Outcome Score (KOOS). The independent t-test was used to compare PROMs between patients with and without periarticular fractures.
Results:
Eighteen patients (10 males, 8 females) with a mean follow-up of 4.0 years (range 1.1-8.6 years) were included in the final analysis, with six patients having MLKIs and concomitant periarticular fractures. Compared to patients with isolated ligamentous MLKIs (n = 12), patients with concomitant periarticular fracture (n = 6) demonstrated significantly worse outcomes on the IKDC-SKF (54.2 ± 13.3 vs. 74.0 ± 19.6, p = 0.04) and KOOS-Sports and Recreation subscale (41.2 ± 32.4 vs. 70.8 ± 19.4, p = 0.03).
Conclusion:
The presence of a periarticular fracture predicted significantly worse clinical outcomes in the setting of MLKI. These findings may be useful in determining the prognosis of MLKI with concomitant periarticular fractures treated with surgical repair and/or reconstruction.
Insights
Periarticular fractures accompanying multiligament knee injuries (MLKIs) significantly worsen patient-reported outcomes. This study found that patients with these combined injuries reported worse knee function and sports participation scores after surgical treatment.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Traumatology
Background:
- Multiligament knee injuries (MLKIs) are complex orthopedic emergencies.
- The impact of concomitant periarticular fractures on outcomes after MLKI treatment remains under-investigated.
- High-level evidence is needed to understand the prognostic implications of combined injuries.
Purpose of the Study:
- To investigate whether periarticular fractures associated with MLKIs lead to poorer patient-reported outcomes (PROMs) compared to MLKIs without fractures.
- To provide evidence for prognosis in MLKI patients with combined periarticular fractures undergoing surgical repair or reconstruction.
Main Methods:
- Retrospective review of medical records for patients aged 18-65 with grade III MLKIs (January 2009-June 2014).
- Exclusion of patients with prior knee injuries/surgeries; inclusion of those with a minimum 1-year follow-up.
- Detection of periarticular fractures via radiographs and CT scans; 1:2 matching of fracture vs. non-fracture groups.
- Collection and comparison of PROMs (IKDC-SKF, KOOS) using independent t-tests.
Main Results:
- Sixteen patients with MLKIs and periarticular fractures were compared to 12 patients with isolated MLKIs.
- Patients with concomitant fractures reported significantly lower IKDC-SKF scores (54.2 vs. 74.0, p=0.04).
- KOOS-Sports and Recreation subscale scores were also significantly worse in the fracture group (41.2 vs. 70.8, p=0.03).
Conclusions:
- Periarticular fractures are a significant negative predictor of clinical outcomes in MLKI patients.
- These findings are crucial for informing prognosis and treatment strategies for MLKIs with associated fractures.
- Surgical management of MLKIs with periarticular fractures may yield poorer functional recovery.
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