Patel Neel K, Lian Jayson, Nickoli Michael, Vaswani Ravi, Irrgang James J, Lesniak Bryson P, Musahl Volker
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
Orthop J Sports Med. 2021 Mar 29;9(3):2325967121994203. doi: 10.1177/2325967121994203. eCollection 2021 Mar.
Many factors can affect clinical outcomes and complications after a complex multiligament knee injury (MLKI). Certain aspects of the treatment algorithm for MLKI, such as the timing of surgery, remain controversial.
To determine the risk factors for common complications after MLKI reconstruction.
Case-control study; Level of evidence, 3.
A retrospective review was conducted on 134 patients with MLKI who underwent reconstruction between 2011 and 2018 at a single academic center. Patients included in the review had a planned surgical reconstruction of >1 ligament based on clinical examination and magnetic resonance imaging. Complications were categorized as (1) wound infection requiring irrigation and debridement, (2) arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions, (3) deep venous thrombosis, (4) need for removal of hardware, and (5) revision ligament surgery. The potential risk factors for complications included patient characteristics, injury pattern categorized according to Schenck classification (knee dislocation [KD] I-KD IV), and timing of surgery. Significant risk factors for complications were analyzed by test, chi-square test, and Fisher exact test.
A total of 108 patients met the inclusion criteria; of these, 29.6% experienced at least 1 complication. Smoking (odds ratio [OR], 3.20 [95% CI, 1.28-8.02]; = .01) and planned staged surgery (OR, 2.71 [95% CI, 1.04-7.04]; = .04) significantly increased the overall risk of complication, while increased time from injury to surgery (OR, 0.99 [95% CI, 0.98-0.998]; < .01) significantly decreased the risk. Increasing time from injury to surgery (OR, 0.99 [95% CI, 0.97-0.998]; = .02) also led to a slightly but significantly decreased risk for arthrofibrosis.
The study findings suggest that smoking, decreased time from injury to initial surgery, and planned staged procedures may increase the rate of complications. Further studies are needed to determine which changes in the treatment algorithm are most effective to reduce the complication rate in patients.
许多因素会影响复杂的膝关节多韧带损伤（MLKI）后的临床结果和并发症。MLKI治疗方案的某些方面，如手术时机，仍存在争议。
确定MLKI重建术后常见并发症的危险因素。
病例对照研究；证据等级，3级。
对2011年至2018年在单一学术中心接受重建手术的134例MLKI患者进行回顾性研究。纳入研究的患者根据临床检查和磁共振成像计划对1条以上韧带进行手术重建。并发症分为：（1）需要冲洗和清创的伤口感染；（2）需要在麻醉下手法操作和/或粘连松解的关节纤维化；（3）深静脉血栓形成；（4）需要取出内固定物；（5）韧带翻修手术。并发症的潜在危险因素包括患者特征、根据申克分类法分类的损伤类型（膝关节脱位[KD]I-KD IV）和手术时机。通过检验、卡方检验和费舍尔精确检验分析并发症的显著危险因素。
共有108例患者符合纳入标准；其中，29.6%至少发生1种并发症。吸烟（优势比[OR]，3.20[95%可信区间，1.28-8.02]；P =.01）和计划分期手术（OR，2.71[95%可信区间，1.04-7.04]；P =.04）显著增加了总体并发症风险，而受伤至手术时间延长（OR，0.99[95%可信区间，0.98-0.998]；P <.01）显著降低了风险。受伤至手术时间延长（OR，0.99[95%可信区间，0.97-0.998]；P =.02）也导致关节纤维化风险略有但显著降低。
研究结果表明，吸烟、受伤至初次手术时间缩短和计划分期手术可能会增加并发症发生率。需要进一步研究以确定治疗方案中的哪些改变对降低患者并发症发生率最有效。
