Outcomes after multiligament knee injury worsen over time: A systematic review and meta-analysis

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-08-28 DOI:10.1002/ksa.12442

Antonio Klasan, Anne Maerz, Sven E. Putnis, Justin J. Ernat, Edouard Ollier, Thomas Neri

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引用次数: 0

Abstract

Purpose

Multiligament knee injuries (MLKIs) are devastating injuries that can have life-long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow-up.

Methods

Four databases were queried for surgical outcome-based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2-year follow-up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow-up period, anatomical region and posterior-cruciate ligament (PCL)-based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random-effects model analysis was performed.

Results

After the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow-up was 4.06 years (range 2–12.7). The mean Lysholm score at 2-year follow-up was 86.09 [95% confidence interval [CI]: 82.90–89.28], with a yearly decrease of −0.80 [95% CI: −1.47 −0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56–86.14], with a yearly decrease of −1.99 [95% CI: −3.14 −0.84] (p < 0.001). Non-PCL-based injuries had a higher IKDC 83.69 [75.55–91.82] vs. 75.00 [70.75–79.26] (p = 0.03) and Lysholm score 90.84 [87.10–94.58] versus 84.35 [82.18–86.52] (p < 0.01) than PCL-based injuries, respectively.

Conclusion

According to the present systematic review and meta-analysis of MLKIs with minimum 2-year follow-ups, the patients who suffered an MLKI can expect to retain around 80-85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL-based injuries at 2 years postoperative.

Level of Evidence

Level IV meta-analysis.

Abstract Image

查看原文本刊更多论文

膝关节多韧带损伤后的疗效随时间推移而恶化：系统回顾和荟萃分析。

目的：膝关节多韧带损伤（MLKIs）是一种破坏性损伤，可造成终身后果。治疗方案需要决定是否进行手术、手术时机、修复与重建的考虑、重建技术和重建移植物的选择。本研究的目的是分析 MLKIs 在至少 2 年的随访期间临床结果的发展情况：方法：在四个数据库中查询了 2000 年 1 月 1 日至 2022 年 9 月 9 日期间发表的至少随访 2 年、基于手术结果的 MLKIs 研究。排除了技术文章、非手术治疗、关节成形术、儿科和综述文章。收集的研究特征包括设计、患者人数、年龄、随访时间、解剖区域和基于后交叉韧带（PCL）的损伤。主要结果为Lysholm、国际膝关节文献委员会（IKDC）结果评分和Tegner活动评分。结果：结果：采用纳入和排除标准后，79 项研究中的 3571 名患者被纳入分析。手术时的平均年龄为 35.6 岁。平均随访时间为 4.06 年（2-12.7 年不等）。随访2年的平均Lysholm评分为86.09[95%置信区间[CI]：82.90-89.28]，每年下降-0.80[95% CI：-1.47-0.13]，（P = 0.0199）。2年后的IKDC平均值为81.35[95% CI：76.56-86.14]，每年下降-1.99[95% CI：-3.14-0.84]（P根据目前对至少随访 2 年的 MLKI 进行的系统回顾和荟萃分析，遭受 MLKI 的患者在 2 年后膝关节功能可望保持在 80%-85% 左右，膝关节功能可望逐年恶化，具体取决于所使用的评分。对于基于 PCL 的损伤，预计术后 2 年的疗效较差：IV级荟萃分析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).