Schneebeli Valentine, Philippe Virginie, Laurent Alexis, Applegate Lee Ann, Martin Robin
Orthopedics Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, Épalinges, Switzerland.
Orthop J Sports Med. 2024 Aug 12;12(8):23259671241261103. doi: 10.1177/23259671241261103. eCollection 2024 Aug.
Multiligament reconstruction (MLR) has become the standard surgical approach for treating multiligament knee injuries (MLKIs).
To identify prognostic factors for patient-reported outcome measures, return to work (RTW), return to sports, and radiographic osteoarthritis (OA) (Kellgren-Lawrence grade ≥2) after MLR for MLKI.
Case-control study; Level of evidence 3.
Included were 52 consecutive patients (age, 35.5 ± 11 years; 75% men), with MLKI sustained between 2013 and 2019 and treated with MLR. At a mean follow-up of 3.8 ± 1.6 years, patient-reported outcome measure scores-including the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI), and the 12-Item Short-Form Health Survey-RTW, return to sports, and weightbearing radiographs were obtained. A total of 20 determinants were hypothesized and tested by univariate logistic regression for binary variables or linear regression for continuous variables. Only factors identified as significant ( < .10) were entered into a multivariate logistic regression model.
The prevalence of injury severity according to the Schenck knee dislocation (KD) classification was as follows: KD I (44%), KD III (36%), KD IV (10%), and KD V (10%). Increased KD grades resulted in decreased IKDC ( = .002) and all 5 KOOS subscales (≤ .007 for all) scores. Medial meniscectomy (23%) was associated with a worse ACL-RSI score ( = .007) and RTW failure (odds ratio [OR], 36.8; = .035). Peroneal nerve palsy (6%) was associated with a worse ACL-RSI score (≤ .001). Radiographic OA was observed in 38%, with distribution predominantly patellofemoral (80%) and medial tibiofemoral (45%). Traumatic cartilage damage (Outerbridge grade >2 [37%]) was associated with secondary patellofemoral (OR, 10; = .012) and medial tibiofemoral (OR, 10; = .019) OA. Anterior cruciate ligament reconstruction failure (7%) was a risk factor for medial tibiofemoral OA (OR, 25.8; = .006).
Increased Schenck KD grade, permanent peroneal nerve palsy, and irreparable medial meniscus lesions were prognostic factors for worse functional outcomes 3.8 years after MLKI was treated with MLR. Traumatic cartilage damage and anterior cruciate ligament failure were associated with the development of early OA.
多韧带重建术（MLR）已成为治疗膝关节多韧带损伤（MLKIs）的标准手术方法。
确定MLR治疗MLKI后患者报告的结局指标、重返工作岗位（RTW）、恢复运动及影像学骨关节炎（OA）（Kellgren-Lawrence分级≥2级）的预后因素。
病例对照研究；证据等级为3级。
纳入2013年至2019年间连续52例MLKI患者（年龄35.5±11岁；75%为男性），均接受MLR治疗。平均随访3.8±1.6年，获取患者报告的结局指标评分，包括国际膝关节文献委员会（IKDC）评分、膝关节损伤与骨关节炎结局评分（KOOS）、前交叉韧带损伤后恢复运动评分（ACL-RSI）以及12项简短健康调查中的RTW评分，同时获取恢复运动情况及负重X线片。共假设20个决定因素，通过单因素逻辑回归分析二元变量或线性回归分析连续变量进行检验。仅将被确定为有显著意义（<0.10）的因素纳入多因素逻辑回归模型。
根据申克膝关节脱位（KD）分类，损伤严重程度的患病率如下：KD I（44%）、KD III（36%）、KD IV（10%）和KD V（10%）。KD分级增加导致IKDC评分降低（P = 0.002）以及所有5个KOOS子量表评分降低（所有P≤0.007）。内侧半月板切除术（23%）与较差的ACL-RSI评分（P = 0.007）及RTW失败相关（比值比[OR]为36.8；P = 0.035）。腓总神经麻痹（6%）与较差的ACL-RSI评分相关（P≤0.001）。38%的患者观察到影像学OA，主要分布于髌股关节（80%）和胫股内侧关节（45%）。创伤性软骨损伤（Outerbridge分级>2级[37%]）与继发性髌股关节（OR为10；P = 0.012）和胫股内侧关节（OR为10；P = 0.019）OA相关。前交叉韧带重建失败（7%）是胫股内侧关节OA的危险因素（OR为25.8；P = 0.006）。
申克KD分级增加、永久性腓总神经麻痹及不可修复的内侧半月板损伤是MLR治疗MLKI 3.8年后功能结局较差的预后因素。创伤性软骨损伤和前交叉韧带失败与早期OA的发生相关。
