Risk Factors for Arthrofibrosis in Schenck KD 3 and 4 Multiligament Knee Injury Patients
Cailan L Feingold1, Eric H Lin1, Pranit Kumaran1
1Keck School of Medicine of USC, Los Angeles, California, USA.
Background:
Multiligament knee injuries (MLKIs) are traumatic, limb-threatening injuries requiring surgical reconstruction, of which Schenck classification for knee dislocation (KD) 3 and 4 MLKIs are the most serious. Arthrofibrosis is a common complication of multiligament knee reconstruction (MLKR).
Purpose:
This study sought to identify risk factors for arthrofibrosis in Schenck KD 3 and 4 MLKI patients.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Patients with Schenck KD 3 or 4 MLKI who underwent MLKR with a single surgeon were identified retrospectively. Patient sociodemographics, injury characteristics, operative details, and postoperative courses were collected. Patients were divided into groups based on development of postoperative arthrofibrosis, defined as failure to reach a range of motion of 0° to 90° or extensor lag ≥10° by 6 weeks or as undergoing manipulation under anesthesia with or without lysis of adhesions. Univariate and chi-square analyses were used to identify associations with arthrofibrosis, and logistic regression was used to confirm risk factors. Statistical significance was defined as P < .05.
Results:
A total of 71 patients with a mean age of 31.5 ± 10.6 and mean follow-up time of 25.1 months were included. Of this total, 23 (32.4%) developed arthrofibrosis postoperatively. Characteristics and variables associated with arthrofibrosis were younger age (28.0 ± 10.4 vs 33.5 ± 10.4 years; P = .04), higher median household income by zip code ($107,066 ± $40,536 vs $83,911 ± $28,530; P = .007), worse preoperative flexion (98.1°± 30.5° vs 120.6°± 22.1°; P = .002), quicker time from injury to surgery (81.6 ± 74.2 days vs 232.5 ± 307.3 days; P = .03), and significantly longer time to return to weightbearing as tolerated (12.0 ± 9.0 weeks vs 7.0 ± 3.4 weeks; P = .005). There were no differences in race, sex, body mass index, insurance type, preoperative extension, use of external fixation, mechanism of injury, or concomitant meniscal repair (P > .05). Logistic regression identified younger age, preoperative flexion, and time to weightbear as risk factors for arthrofibrosis (P = .004, .014, .019, respectively).
Conclusion:
A third of MLKI KD 3 and 4 patients who underwent reconstruction developed arthrofibrosis. Younger patients, those with worse preoperative flexion, and those who take longer to return to weightbearing as tolerated are at risk of arthrofibrosis. Time to weightbearing and preoperative flexion may be modifiable by prehabilitation or manipulation under anesthesia at earlier stages.
