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Review
. 2024 Jul 19;58(9):1175-1187.
doi: 10.1007/s43465-024-01224-1. eCollection 2024 Sep.

Effect of Timing of Surgery on the Outcomes and Complications in Multi-ligament Knee Injuries: An Overview of Systematic Reviews and A Meta-analysis

Raju Vaishya  1 , Mohit Kumar Patralekh  2 , Abhishek Vaish  1 , Luke V Tollefson  3 , Robert F LaPrade  3
Affiliations
Review

Effect of Timing of Surgery on the Outcomes and Complications in Multi-ligament Knee Injuries: An Overview of Systematic Reviews and A Meta-analysis

Raju Vaishya et al. Indian J Orthop. .

Abstract

Background and aims: Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI.

Methods: A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of relevant keywords encompassing "multi-ligament knee injury," "knee dislocation," "reconstruction," "repair," "surgery," and "timing," and their synonyms, along with appropriate Boolean operators. Selection of articles (systematic reviews and meta-analyses) adhered to predefined inclusion and exclusion criteria. Furthermore, a meta-analysis was conducted utilizing data extracted from primary studies.

Results: Early surgery for MLKI demonstrated a significant advantage over delayed surgery, reflected by significantly higher Lysholm scores (Mean Difference [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22), IKDC objective scores (Mantel-Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69), Tegner activity scores (MD 0.38; 95% CI 0.08, 0.69), and Mayer's ratings (MH-OR 5.47; 95% CI 1.27, 23.56). In addition, we found a significantly reduced risk of secondary chondral lesions (MH-OR 0.33; 95% CI 0.23, 0.48), lower instrumented anterior tibial translation in the early surgery group (MD -0.92; 95% CI -1.83, -0.01), but no significant difference was observed in the secondary meniscal tears, between the two groups. However, the early surgery group also exhibited a significantly increased risk of knee stiffness (MH-OR 2.47; 95% CI 1.22, 5.01) and a greater likelihood of requiring manipulation under anaesthesia (MH-OR 3.91; 95% CI 1.10, 13.87).

Conclusion: Early surgery for MLKI improves function, and stability, and reduces further articular cartilage damage, but increases the risk of stiffness.

Level of evidence: IV.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01224-1.

Keywords: Anterior cruciate ligament injuries; Cartilage; Joint stiffness; Knee dislocation; Knee injuries; Multi-ligament injury.

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Conflict of interest statement

Conflict of InterestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the study
Fig. 2
Fig. 2
Risk of Bias in systematic reviews by AMSTAR2 tool
Fig. 3
Fig. 3
Funnel plot for Lysholm scores showing no publication bias
See this image and copyright information in PMC

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