Complication Rates From Multiligament Knee Repair

While multiligament knee injuries are rare, say the authors of a new study, when they do occur, they can have complication rates as high as 30% and wreak havoc on a patient’s life. Their study, “Intraoperative and Early (90-Day) Postoperative Complications and Associated Variables with Multiligamentous Knee Reconstruction: 15-year Experience from a Single Academic Institution,” appears in the May 27, 2021 edition of Arthroscopy: The Journal of Arthroscopic and Related Surgery.

OrthoCarolina assistant professor of orthopedic surgery Bryan Saltzman, M.D., co-author on this work, explained to OTW that the primary objective of this study was to better characterize the complications and patient specific variables which are typically associated with multiligament knee injuries. “Multiligament knee injuries have been studied, with intermediate and long-term outcome studies demonstrating worse outcomes with operative as well as nonoperative management when compared to single ligament injury.”

“The rates of complications are high and vary widely, and prior studies have been limited in their ability to characterize complications and associated variables (patient demographics, injury characteristics, surgical techniques). The previously available literature lacked high-level evaluations of intraoperative and early (90-day) complication rates and associated variables.”

OrthoCarolina patients who had multiligament knee surgery from 2005-2019 comprised the study group. Inclusion criteria were: intervention with two or more ligament reconstructions performed concurrently, and more than 90 days postoperative follow-up. Those excluded were patients who had undergone revision ligamentous knee surgery.

Multiple Concerns

“Our institution’s 15-year experience most notably demonstrated a rate of 3% intraoperative complications, and 30% postoperative complications. Some of the highlightable findings were that shorter time from injury to date of surgery was associated with arthrofibrosis and superficial wound infections, and operative time greater than 300 minutes was associated with intraoperative blood transfusions, deep infections, and arthrofibrosis. Tibial-based PLC [posterolateral corner] reconstruction was associated with more symptomatic hardware and arthrofibrosis than its fibular-based counterpart. Finally, PCL reconstruction was associated with deep infections, arthrofibrosis, and postoperative blood transfusions.”

“Our 15-year data reveals that there is a low intraoperative complication rate but a high early postoperative complication rate with multiligamentous knee surgery. Surgeons should be wary of the increased risks associated with longer procedure times, inside-out meniscal repair, tibial-based PLC reconstruction, PCL reconstruction, and shorter time to surgery.”