This article is more than 5 years old. Information may no longer be current.
No differences found for early vs delayed treatment of multiligament knee injuries
BOSTON — Although early vs. delayed surgical treatment of multiligament knee injuries had no differences in patient-reported outcomes, results presented here showed older age was independently predictive of poor pain, stiffness and instability regardless of time from injury to surgical intervention.
Ryan M. Khan, BSc, and colleagues stratified 152 patients with multiligament knee injuries to either early (n=85) or delayed (n=67) surgical intervention. Researchers compared patient-reported outcomes between the early and delayed groups, and analyzed associations between age, gender, BMI, injury severity, associated nerve injuries and reoperation rates.
“In regard to mechanism of injury, [there were] no differences between sports, low-energy, high-energy or crush mechanism of injury,” Khan said in his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting.
Results also showed no significant differences between the two groups with respect to age, gender distribution, BMI or severity of injury. More patients had lateral-sided injuries and nerve injuries at initial presentation in the early surgery group, while more patients in the delayed surgery group had posterior cruciate ligament involvement.
Researchers found 32% of patients underwent repeat operation including manipulation under anesthesia, arthroscopic debridement, removal of hardware, revision and/or conversion to total knee arthroplasty. However, results showed no significant differences in reoperation rates between the two groups.
“[We found no] difference in range of motion, both flexion and extension, and no difference in laxity based on clinical exam for early vs. late surgery,” Khan said. “We did find, however, that age was an independent predictor of more pain, more stiffness and instability.” – by Casey Tingle
Reference:
Whelan DB, et al. Abstract 54. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Khan reports he has no relevant financial disclosures.
Perspective
Back to Top
This paper by Daniel B. Whelan, MD, MSc, and colleagues evaluated timing of surgery for multiple ligament knee injuries. Historically, there have been stiffness/adhesion concerns with acute surgery that have led some surgeons to consider delayed surgical management. Recent studies, however, have noted better results with ligament reconstruction (posterolateral corner injuries) in comparison to repairs, and that immediate range of motion and sometimes limited weight bearing can be instituted with reconstructions without the same level of concern for subsequent laxity or loss of fixation seen with repairs. Although acute surgical management is now preferred by many surgeons, delayed surgery can be seen with severe soft tissue injury, delay in diagnosis or referral or inadequate surgical treatment with subsequent failure and chronic instability making this study an important topic. The current study found no significant subjective outcomes or reoperation rate differences between acute (mean 16.7 days) vs. chronic (mean 253 days) surgery and poorer results in both groups with older age in a large cohort of 152 patients. Future studies should include an additional evaluation of objective stability (stress radiography, KT measurements, physical examination) and return to athletic activity as it relates to surgical timing for these challenging multiple ligament knee injuries.
References:
Jiang W, et al. Knee Surg Sports Traumatol Arthrosc. 2015;doi:10.1007/s00167-014-3435-1.
LaPrade RF, et al. Am J Sports Med. 2018;doi:10.1177/0363546518784301.
Levy BA, et al. Am J Sports Med. 2010;doi:10.1177/0363546509352459.
Levy BA, et al. Arthroscopy. 2009;doi:10.1016/j.arthro.2009.01.008.
McCarthy M, et al. Iowa Orthop J. 2015;35:20-25.
and hip sports medicine
Twin Cities Orthopedics
Read more about