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. 2025 Jul 28;13(7):23259671251356696.
doi: 10.1177/23259671251356696. eCollection 2025 Jul.

Medial and Patellofemoral Compartment Chondral Damage Increases With Delayed Surgical Treatment of Multiligament Knee Injuries

Collin D R Hunter  1 , Joseph Featherall  1 , Natalya McNamara  1 , Patrick Greis  1 , Travis G Maak  1 , Stephen K Aoki  1 , Antonio Klasan  2 , Justin J Ernat  1
Affiliations

Medial and Patellofemoral Compartment Chondral Damage Increases With Delayed Surgical Treatment of Multiligament Knee Injuries

Collin D R Hunter et al. Orthop J Sports Med. .

Abstract

Background: Multiligament knee injuries (MLKIs) are complex and challenging, with significant long-term consequences. While previous studies have examined chondral injuries in MLKI over time, there are limited data regarding their development during the interval between injury and surgery.

Hypothesis: MLKIs with increased time interval between injury and surgery will be associated with an increased incidence of chondral injuries.

Study design: Case-control study; Level of evidence, 3.

Methods: This retrospective review utilized a multisurgeon database, including patients with MLKI treated from April 2008 to October 2022. Inclusion criteria were MLKI requiring surgical intervention, available operative reports, and documented date of injury in the electronic medical record. MLKIs were categorized by time interval from injury to surgery (acute, 0-90 days; delayed, 91-365 days; late, >365 days). The location and pattern of meniscal and chondral injuries were evaluated accordingly. Compartment injury patterns were also analyzed based on cruciate ligament injury pattern.

Results: A total of 206 patients were included (acute, n = 138; delayed, n = 54; late, n = 14). The delayed and late groups had significantly higher mean numbers of chondral surface injury (out of 6 total surfaces evaluated) compared with the acute group (delayed, 1.79; late, 1.52; acute, 0.70; P = .002). Trochlear cartilage injuries occurred significantly more frequently in the delayed (28%) compared with the acute group (9%; P = .003). Similarly, patellar cartilage injuries were more common in the delayed (30%) compared with acute patients (12%; P = .02). Medial femoral condylar chondral injuries were significantly increased in the delayed (30%) and late (50%) groups compared with acute (15%; P = .002). Medial tibial plateau cartilage injuries followed the same pattern (acute, 13%; delayed, 30%; late, 43%; P = .002). Patients with bicruciate MLKIs undergoing surgery after 90 days showed significantly higher trochlear (31% vs 8%; P = .04) and patellar cartilage injury rates (35% vs 11%; P = .03). ACL-based MLKIs operated beyond 90 days had increased rates of trochlear (22% vs 8%; P = .03), medial femoral condylar (30% vs 13%; P = .02), and medial tibial plateau (27% vs 11%; P = .03) cartilage injury. PCL-based MLKI patients undergoing delayed surgery (>90 days) also had significantly higher medial femoral condylar (71% vs 8%; P = .004) and medial tibial plateau (71% vs 8%; P = .01) cartilage injury rates. Meniscal injury rates did not differ significantly across time groups.

Conclusion: Patients who underwent delayed surgery for their MLKI injuries had more medial and patellofemoral cartilage injuries at the time of surgery than those treated within 30 days of injury.

Keywords: ACL; PCL; cartilage; meniscus; multiligament knee injury.

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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: J.F. has received hospitality payments from Stryker, Globus Medical, and Stryker. P.G. has received hospitality payments from Smith & Nephew. J.J.E. has received consulting fees from Medical Device Business Services and DePuy Synthes; hospitality payments from Medical Device Business Services and DePuy Synthes; a grant from Arthrex; and support for education from Arthrex, Gemini Mountain Medical, and Smith & Nephew. T.G.M. has received consulting fees, other compensation, and nonconsulting fees from Arthrex and education payments from Arthrex and Active Medical. S.K.A. has received consulting fees from Stryker. 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. Ethical approval for this study was obtained from the University of Utah (No. 174976).

Figures

The image provided is a graph showing the distribution of meniscus and chondral injuries by the timing of intervention. There are three categories of timing: early, delayed, and late. The early category is represented by a light gray bar, the delayed category by a dark gray bar, and the late category by a medium gray bar. The x-axis of the graph represents the different types of injuries, including trochlear, patellar, medial meniscus, MFP, MTP, LFC, lateral meniscus, LFC, and LTP. The y-axis represents the percentage of patients, ranging from 0% to 60%. The graph shows that the percentage of patients varies for each type of injury and timing of intervention. For example, the percentage of patients with trochlear injuries with early intervention is around 10%, while the percentage for early intervention with delayed and late intervention is around 20% and 30%, respectively. The percentage of patients with patellar injuries with early intervention is around 10%, while the percentage for early and early intervention is around 20% and 30%, respectively. The percentage of patients with meniscus injuries with early intervention is around 40%, while the percentage for early and early intervention is around 40% and 50%, respectively. The percentage of patients with MFP injuries with early intervention is around 40%, while the percentage for early and early intervention is around 40% and 50%, respectively. The percentage of patients with MTP injuries with early intervention is around 40%, while the percentage for early and early intervention is around 40% and 50%, respectively. The percentage of patients with LFC injuries with early intervention is around 40%, while the percentage for early and early intervention is around 40% and 50%, respectively. The percentage of patients with LFC injuries with delayed intervention is around 40%, while the percentage for early intervention and early intervention is around 50% and 50%, respectively. The percentage of patients with LFC injuries with late intervention is around 40%, while the percentage for early intervention, early intervention, and early intervention is around 50% and 50%, respectively. The percentage of patients with LTP injuries with early intervention is around 40%, while the percentage for early intervention and early intervention is around 50% and 50%, respectively. The percentage of patients with LTP injuries with delayed intervention is around 40%, while the percentage for early intervention and early
Figure 1.
Rate of meniscal and chondral injuries categorized and assessed by time intervals: early (0-90 days), delayed (91-365 days), and late (>365 days). *Trochlear and patellar cartilage injuries with late and delayed intervention were combined for statistical analyses. **Significant difference detected at the P < .05 level of significance. LFC, lateral femoral condyle; LTP, lateral tibial plateau; MTP, medial tibial plateau.
See this image and copyright information in PMC

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References

    1. Alentorn-Geli E, Lazarides AL, Utturkar GM, et al. Factors predictive of poorer outcomes in the surgical repair of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc. 2019;27(2):445-459. doi: 10.1007/s00167-018-5053-9 - DOI - PubMed
    1. Barfield WR, Holmes RE, Slone H, Walton ZJ, Hartsock LA. Acute versus staged surgical intervention in multiligamentous knee injuries: a review of the literature since 2009. Curr Orthop Pract. 2015;26(5):530-535.
    1. Braaten JA, Schreier FJ, Rodriguez AN, Monson J, LaPrade RF. Modern treatment principles for multiligament knee injuries. Arch Bone Jt Surg. 2022;10(11):937. doi: 10.22038/ABJS.2021.60188.2971 - DOI - PMC - PubMed
    1. Burrus MT, Werner BC, Griffin JW, Gwathmey FW, Miller MD. Diagnostic and management strategies for multiligament knee injuries a critical analysis review. JBJS Rev. 2016;4(2):e1. doi: 10.2106/JBJS.RVW.O.00020 - DOI - PubMed
    1. Cook S, Ridley TJ, McCarthy MA, et al. Surgical treatment of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2983-2991. doi: 10.1007/s00167-014-3451-1 - DOI - PubMed

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