Outcomes of acute versus delayed multi-ligament knee injury reconstruction: A retrospective analysis with mean 3.6-year follow-up.

Abstract

Multi-ligament knee injuries (MLKIs) are debilitating injuries, often managed with surgical reconstruction. Our purpose was to determine whether acute or delayed reconstruction led to better functional and patient-reported outcomes. An institutional dataset was queried for patients who underwent MLKI reconstruction from 2012 to 2019 and completed postoperative functional and patient-reported outcome surveys with minimum 2-year follow-up. Exclusion criteria included single ligament reconstruction, revision surgery, and periarticular tumors. Patient-reported outcomes measurement system (PROMIS) and multi-ligament quality of life (ML-QoL) outcomes were compared between patients who underwent acute (< 2 weeks) and delayed (> 2 weeks) reconstruction. Thirty-three patients were included for analysis (16 acute, 17 delayed): mean follow-up 3.6 years, mean BMI 29.8 ± 5.9, mean age 37.7 ± 13.5, sex: 19(58%) females, 14(42%) males. At final follow-up, there was no statistical difference between groups in most PROMIS scores, including Lysholm knee score (63 vs. 72, p = 0.13), pain (53 vs. 47, p = 0.11), or mobility (45 vs. 49, p = 0.18). Patients who underwent delayed reconstruction demonstrated significantly higher physical function scores (46 vs. 53, p = 0.05). There was no statistical difference in majority of ML-QoL scores, including physical impairments (42 vs. 29, p = 0.09), emotional impairments (45 vs. 30, p = 0.12), and societal involvement (38 vs. 24, p = 0.09). Patients who underwent acute reconstruction reported statistically greater activity limitations than delayed reconstruction (36 vs. 21, p = 0.02). There were no significant differences in complication rates between groups. Delayed MLKI reconstruction had comparable results to acute reconstruction for PROMIS and ML-QoL outcomes, and had greater physical function and lower activity limitation postoperatively. These data demonstrate that delayed reconstruction may be an appropriate management option for MLKI reconstruction. Level III, Retrospective Cohort study.