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Surgeon experience in multi-ligament knee injury reconstruction is associated with decreased complications and
Emily Berzolla1, Bradley A Lezak2, Steven Magister1
1New York University Langone Orthopedic Hospital, New York, NY, USA.
Introduction:
Operative management of multi-ligament knee injuries (MLKI) is technically challenging, with high complication rates. However, the impact of surgeon experience on surgical outcomes remains underreported. This purpose of this study was to examine how surgeon experience impacts operative time and complication rates. It was hypothesized that increased surgeon experience in MLKI correlates with reduced surgical duration and postoperative complications.
Methods:
A retrospective review of MLKI patients who underwent reconstruction from 2011 to 2024 by fellowship-trained sports medicine surgeons at two high-volume level 1 trauma centers was conducted. Patient demographics, surgical procedure characteristics, complications, and surgeon experience (defined by years in practice postfellowship) were analyzed. Correlations were examined using linear regression for continuous variables and binary logistic regression for binary variables.
Results:
There were 191 MLKI patients meeting inclusion criteria, with a 25.7% overall complication rate. Arthrofibrosis (16.2%) was most common, followed by recurrent instability (3.7%), infection (3.7%), revision surgery (2.7%), and hardware removal (1.0%). Controlling for age, sex, BMI, and number of ligaments reconstructed, we found a significant negative correlation between surgeon experience and both surgical duration (ß = - 0.28, p < .001) and complication risk (OR 0.92, p = 0.024).
Conclusion:
This study demonstrates that increased surgeon experience in operative management of MLKI is associated with decreased complication rates and shorter procedure duration. Additional risk factors for complications included the number of ligaments injured and concomitant knee dislocation.
Insights
Increased surgeon experience in multi-ligament knee injury (MLKI) surgery significantly reduces operative time and complication risks. This finding highlights the importance of experienced surgeons for better outcomes in complex knee reconstructions.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Knee Biomechanics
Background:
- Multi-ligament knee injuries (MLKI) present significant surgical challenges with high complication rates.
- The influence of surgeon experience on outcomes for MLKI is not well-documented.
- This study addresses the gap in understanding surgeon experience's impact on MLKI management.
Purpose of the Study:
- To investigate the relationship between surgeon experience and surgical outcomes in MLKI.
- To determine if increased surgeon experience correlates with reduced operative time.
- To assess if greater surgeon experience is associated with lower complication rates in MLKI patients.
Main Methods:
- Retrospective review of 191 MLKI patients undergoing reconstruction between 2011 and 2024.
- Analysis of patient demographics, surgical details, and complications.
- Correlation analysis using linear and logistic regression, defining surgeon experience by years post-fellowship.
Main Results:
- A 25.7% overall complication rate was observed, with arthrofibrosis being most frequent.
- Significant negative correlation found between surgeon experience and operative duration (p < .001).
- Increased surgeon experience was linked to a lower risk of complications (OR 0.92, p = .024), even after controlling for confounding factors.
Conclusions:
- Greater surgeon experience in MLKI surgery is associated with shorter operative times.
- Experienced surgeons demonstrate reduced complication rates in managing complex knee injuries.
- Number of ligaments injured and knee dislocation are additional risk factors for complications.
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