Arthritis After Multiligamentous Knee Injuries: a Systematic Review and Meta-Analysis

To evaluate the incidence of knee arthritis following multiligamentous knee injuries (MLKIs) and assess other outcomes including conversion to total knee arthroplasty (TKA), return to work, return to sports, and patient satisfaction.

A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted for studies published up to April 2024. Studies focusing on patients with multiligamentous knee injuries undergoing reconstruction were included. Primary outcome was arthritis incidence; secondary outcomes included conversion to TKA, return to work, return to sports, and patient satisfaction. Data extraction and statistical analyses were performed using MedCalc statistic software, with pooled incidence rates calculated via random-effects models. Heterogeneity was assessed using Cochran's Q test and I² statistic.

Seven studies met the inclusion criteria. The meta-analysis revealed a high incidence of knee arthritis after MLKIs, with a pooled incidence of 65.0% (95% CI 35.4% to 89.4%) among 158 patients, indicating substantial heterogeneity (I² = 92.9%). Conversion to TKA was reported in four studies with a pooled rate of 9.5% (95% CI: 5.4% to 14.6%) across 151 patients (I² = 0%). Return to work was reported in two studies, showing a pooled rate of 93.5% (95% CI: 71.0% to 99.7%) among 59 patients (I² = 83.4%). Return to sports was assessed in three studies, with a pooled rate of 70.8% (95% CI 48.2% to 88.9%) among 73 patients (I² = 75.0%). Patient satisfaction, reported in two studies, demonstrated a pooled rate of 82.5% (95% CI 73.0% to 90.2%) among 72 patients (I² = 0%).

MLKIs are associated with a high incidence of arthritis. However, it remains an effective intervention that facilitates a high rate of return to work, sports participation, and patient satisfaction.