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Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury
Neel K Patel1, Jayson Lian1,2, Michael Nickoli1
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Background:
Many factors can affect clinical outcomes and complications after a complex multiligament knee injury (MLKI). Certain aspects of the treatment algorithm for MLKI, such as the timing of surgery, remain controversial.
Purpose:
To determine the risk factors for common complications after MLKI reconstruction.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
A retrospective review was conducted on 134 patients with MLKI who underwent reconstruction between 2011 and 2018 at a single academic center. Patients included in the review had a planned surgical reconstruction of >1 ligament based on clinical examination and magnetic resonance imaging. Complications were categorized as (1) wound infection requiring irrigation and debridement, (2) arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions, (3) deep venous thrombosis, (4) need for removal of hardware, and (5) revision ligament surgery. The potential risk factors for complications included patient characteristics, injury pattern categorized according to Schenck classification (knee dislocation [KD] I-KD IV), and timing of surgery. Significant risk factors for complications were analyzed by t test, chi-square test, and Fisher exact test.
Results:
A total of 108 patients met the inclusion criteria; of these, 29.6% experienced at least 1 complication. Smoking (odds ratio [OR], 3.20 [95% CI, 1.28-8.02]; P = .01) and planned staged surgery (OR, 2.71 [95% CI, 1.04-7.04]; P = .04) significantly increased the overall risk of complication, while increased time from injury to surgery (OR, 0.99 [95% CI, 0.98-0.998]; P < .01) significantly decreased the risk. Increasing time from injury to surgery (OR, 0.99 [95% CI, 0.97-0.998]; P = .02) also led to a slightly but significantly decreased risk for arthrofibrosis.
Conclusion:
The study findings suggest that smoking, decreased time from injury to initial surgery, and planned staged procedures may increase the rate of complications. Further studies are needed to determine which changes in the treatment algorithm are most effective to reduce the complication rate in patients.
Insights
Smoking and planned staged surgery increase complications after complex multiligament knee injury (MLKI) reconstruction. Shorter time to surgery may reduce risks, but further research is needed for optimal treatment algorithms.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Knee Reconstruction
Background:
- Complex multiligament knee injuries (MLKI) have variable outcomes influenced by numerous factors.
- The optimal timing of surgical intervention for MLKI remains a subject of debate.
Purpose of the Study:
- To identify significant risk factors associated with common complications following MLKI reconstruction.
- To inform the development of improved treatment protocols for MLKI.
Main Methods:
- Retrospective case-control study of 108 patients undergoing MLKI reconstruction.
- Analysis of patient demographics, injury patterns (Schenck classification), and surgical timing as potential risk factors.
- Complications included wound infection, arthrofibrosis, deep venous thrombosis, hardware issues, and revision surgery.
Main Results:
- Nearly 30% of patients experienced at least one complication.
- Smoking (OR 3.20) and planned staged surgery (OR 2.71) were significant risk factors for overall complications.
- Increased time from injury to surgery was associated with a decreased risk of overall complications (OR 0.99) and arthrofibrosis (OR 0.99).
Conclusions:
- Smoking, reduced time to initial surgery, and staged procedures may elevate complication rates in MLKI reconstruction.
- Further investigation is required to optimize treatment algorithms and minimize complication rates in MLKI patients.
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