High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction

Marcel Faraco Sobrado; Pedro Nogueira Giglio; Marcelo Batista Bonadio; Jose Ricardo Pecora; Riccardo Gomes Gobbi; Fabio Janson Angelini; Camilo Partezani Helito

doi:10.1055/s-0040-1722348

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2022; 35(10): 1147-1152
DOI: 10.1055/s-0040-1722348

Original Article

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction

Authors

Marcel Faraco Sobrado

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

²Hospital Sírio Libanês, São Paulo, Brazil
Pedro Nogueira Giglio

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Marcelo Batista Bonadio

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Jose Ricardo Pecora

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Riccardo Gomes Gobbi

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Fabio Janson Angelini

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Camilo Partezani Helito

¹Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

²Hospital Sírio Libanês, São Paulo, Brazil

Abstract

The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% (n = 10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n = 40) presented a KL classification of ≥2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n = 7) also presented arthritis in the contralateral knee, in 53.2% (n = 33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio = 13.2 [p = 0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.

Keywords

knee dislocation - multiple ligament knee injury - osteoarthritis - chronic ligament injury

Full Text

References

References
1 Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 2014; 472 (09) 2621-2629
2 Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br 2006; 88 (06) 706-711
3 Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol 2008; 37 (07) 653-661
4 Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 1997; 11 (07) 525-529
5 Dedmond BT, Almekinders LC. Operative versus nonoperative treatment of knee dislocations: a meta-analysis. Am J Knee Surg 2001; 14 (01) 33-38
6 Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 2002; 30 (05) 718-727
7 Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21 (09) 1967-1976
8 Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 2009; 37 (07) 1434-1443
9 Lie MM, Risberg MA, Storheim K, Engebretsen L, Øiestad BE. What's the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review. Br J Sports Med 2019; 53 (18) 1162-1167
10 Poulsen E, Goncalves GH, Bricca A, Roos EM, Thorlund JB, Juhl CB. Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis. Br J Sports Med 2019; 53 (23) 1454-1463
11 Hantes M, Fyllos A, Papageorgiou F, Alexiou K, Antoniou I. Long-term clinical and radiological outcomes after multiligament knee injury using a delayed ligament reconstruction approach: a single-center experience. Knee 2019; 26 (06) 1271-1277
12 Fanelli GC, Sousa PL, Edson CJ. Long-term followup of surgically treated knee dislocations: stability restored, but arthritis is common. Clin Orthop Relat Res 2014; 472 (09) 2712-2717
13 Moatshe G, Dornan GJ, Ludvigsen T, Løken S, LaPrade RF, Engebretsen L. High prevalence of knee osteoarthritis at a minimum 10-year follow-up after knee dislocation surgery. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3914-3922
14 Helito CP, Sobrado MF, Giglio PN. et al. Clinical outcomes of posterolateral complex reconstruction performed with a single femoral tunnel. J Knee Surg 2021; 34 (01) 67-73
15 Angelini FJ, Helito CP, Tozi MR. et al. Combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel. Arthrosc Tech 2013; 2 (03) e285-e288
16 Bonadio MB, Helito CP, Foni NO. et al. Combined reconstruction of the posterior cruciate ligament and medial collateral ligament using a single femoral tunnel. Knee Surg Sports Traumatol Arthrosc 2017; 25 (10) 3024-3030
17 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
18 Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S208-S228
19 Angelini FJ, Bonadio MB, Helito CP, da Mota E Albuquerque RF, Pécora JR, Camanho GL. Description of the posterolateral rotatory drawer maneuver for the identification of posterolateral corner injury. Arthrosc Tech 2014; 3 (02) e299-e302
20 Angelini FJ, Helito CP, Bonadio MB, da Mota E Albuquerque RF, Pecora JR, Camanho GL. Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator. Orthop Traumatol Surg Res 2015; 101 (01) 77-81
21 Stannard JP, Sheils TM, McGwin G, Volgas DA, Alonso JE. Use of a hinged external knee fixator after surgery for knee dislocation. Arthroscopy 2003; 19 (06) 626-631
22 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22 (03) 276-282
23 Schenck R. Classification of knee dislocations. Oper Tech Sports Med 2003; 11 (03) 193-198
24 Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg 2008; 21 (04) 261-268
25 Hirschmann MT, Zimmermann N, Rychen T. et al. Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair. BMC Musculoskelet Disord 2010; 11: 102
26 Helito CP, Bonadio MB, Demange MK. et al. Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up. Int Orthop 2015; 39 (03) 543-548
27 Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81 (09) 646-656
28 Noyes FR, Barber-Westin SD. Long-term assessment of posterolateral ligament femoral-fibular reconstruction in chronic multiligament unstable knees. Am J Sports Med 2011; 39 (03) 497-505
29 Krych AJ, Sousa PL, King AH, Engasser WM, Stuart MJ, Levy BA. Meniscal tears and articular cartilage damage in the dislocated knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3019-3025
30 Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc Rev 2011; 19 (02) 167-173
31 Levy BA, Marx RG. Outcome after knee dislocation. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1011-1012
32 Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral corner of the knee: current concepts. Arch Bone Jt Surg 2016; 4 (02) 97-103
33 Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: surgical treatment of acute injuries. Am J Sports Med 2016; 44 (05) 1336-1342
34 Moulton SG, Geeslin AG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 2: surgical treatment of chronic injuries. Am J Sports Med 2016; 44 (06) 1616-1623
35 Bonanzinga T, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Neri MP, Marcacci M. Management of combined anterior cruciate ligament-posterolateral corner tears: a systematic review. Am J Sports Med 2014; 42 (06) 1496-1503
36 Angelini FJ, Helito CP, Bonadio MB. et al. External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3012-3018