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. 2021 Mar 29;9(3):2325967121994203.
doi: 10.1177/2325967121994203. eCollection 2021 Mar.

Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury

Neel K Patel  1 , Jayson Lian  1   2 , Michael Nickoli  1 , Ravi Vaswani  1 , James J Irrgang  1   3 , Bryson P Lesniak  1 , Volker Musahl  1
Affiliations

Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury

Neel K Patel et al. Orthop J Sports Med. .

Abstract

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.

Keywords: knee dislocation; multiligament knee injury; multiligament knee reconstruction; risk factors.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: N.K.P. has received education payments from Mid-Atlantic Surgical. M.N. has received grant support from Arthrex; education payments from Arthrex, CDC Medical, and Smith & Nephew; and hospitality payments from Stryker. R.V. has received education payments from Mid-Atlantic Surgical. V.M. has received consulting fees from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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