Early reconstruction of multiligament knee injuries increases postoperative arthrofibrosis compared with delayed reconstruction: study

Graeme Hoit et al conducted a study to compare outcomes following early compared with delayed reconstruction in patients with multi ligament knee injury (MLKI).

A retrospective cohort analysis of patients with MLKI was conducted at St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada. Patients who underwent a reconstructive surgical procedure with more than12 months of postoperative follow-up were included. Patients were stratified into early reconstruction (<6 weeks after the injury) and delayed reconstruction (12 weeks to 2 years after the injury). Multivariable regression models with inverse probability of treatment weighting (IPTW) were utilized to compare the timing of the surgical procedure with the primary outcome (the Multiligament Quality of Life questionnaire [MLQOL]) and the secondary outcomes (manipulation under anesthesia [MUA], Kellgren-Lawrence [KL] osteoarthritis grade, knee laxity, and range of motion).

Key findings of the study were:

• A total of 131 patients met the inclusion criteria, with 75 patients in the early reconstruction group and 56 patients in the delayed reconstruction group.

• The mean time to the surgical procedure was 17.6 days in the early reconstruction group compared with 280 days in the delayed reconstruction group.

• The mean postoperative follow-up was 58 months.

• The early reconstruction group, compared with the delayed reconstruction group, included more lateral-sided injuries (49 patients [65%] compared with 23 [41%]; standardized mean difference [SMD], 0.44) and nerve injuries (36 patients [48%] compared with 9 patients [16%]; SMD, 0.72), and had a higher mean Schenck class (SMD, 0.57).

• After propensity adjustment, there was no difference between early and delayed reconstruction across the 4 MLQOL domains (p > 0.05).

• Patients in the early reconstruction group had higher odds of requiring MUA compared with the delayed reconstruction group (24 [32%] compared with 8 [14%]; IPTW-adjusted odds ratio [OR], 3.85 [95% confidence interval (CI), 2.04 to 7.69]; p < 0.001) and had less knee flexion at the most recent follow-up (b, 6.34_ [95% CI, 0.91_ to 11.77_]; p = 0.023).

• Patients undergoing early reconstruction had lower KL osteoarthritis grades compared with patients in the delayed reconstruction group (OR, 0.46 [95% CI, 0.29 to 0.72]; p < 0.001). There were no differences in clinical laxity between groups.

The authors concluded that – “Early reconstruction of MLKIs likely increases the likelihood of postoperative arthrofibrosis compared with delayed reconstruction, but it may be protective against the development of osteoarthritis. When considering the timing of MLKI reconstruction, surgeons should consider the benefit that early reconstruction may convey on long-term outcomes but should caution patients regarding the possibility of requiring an MUA.

Level of Evidence: Therapeutic Level III.

Further reading:

Early Compared with Delayed Reconstruction in Multiligament Knee Injury A Retrospective Propensity Analysis Graeme Hoit et al J Bone Joint Surg Am. 2024;106:1903-9 http://dx.doi.org/10.2106/JBJS.23.00795