External Fixator Application, 2-Stage Procedures, and Postoperative Infection Risk Are Higher in Multiligamentous Knee Injuries After Frank Knee Dislocations.

PURPOSE

To examine outcomes after surgical treatment of multiligamentous knee injuries (MLKIs) in patients with dislocated versus non-dislocated knees.

METHODS

Patients who were surgically treated for MLKIs between 2008 and 2021 were included in this study. Patients were divided into 2 groups: those with a frank knee dislocation (KD), diagnosed by radiographs or reduction notes in the emergency department, and those without a frank KD (non-KD). The following patient-reported outcome measures were collected: visual analog scale for pain, International Knee Documentation Committee subjective score, and Lysholm knee scoring scale. Additional procedures such as revision ligamentous reconstruction and complications such as infection and arthrofibrosis were also obtained.

RESULTS

A total of 88 patients (88 knees; 36 KD vs 52 non-KD) were included in the final analysis. This study included 30 female and 58 male patients, and the mean age was 34.3 ± 12.7 years (range, 10-61 years). The mean follow-up period for the patients who did not receive revision surgery was 9.2 years (range, 3.4-15.3 years). There were no differences in age, sex, mechanism of injury, meniscal/chondral injury, or neurovascular status between the groups. Furthermore, there were no differences in visual analog scale, International Knee Documentation Committee, or Lysholm scores. Significantly more patients in the KD group showed higher KD grades (KD III-KD V, 29 [81%] vs 21 [40%]; < .001), and significantly more KD I injuries were observed in the non-KD group (48.1% vs 11.1%, < .001). More patients in the KD group underwent staged procedures (69.4% vs 28.8%, < .001) and had external fixators applied (50% vs 5.8%, < .001). The overall complication rate was comparable between groups, with no differences in revision surgery or arthrofibrosis; however, the KD group had a higher postoperative infection rate (16.7% vs 1.9%,  = .017).

CONCLUSIONS

Patients who experienced frank KDs showed an increased odds of receiving external fixation, showed an increased odds of undergoing a staged procedure, had higher grades of injury, and had a higher risk of postoperative infection compared with those without KDs. At final follow-up, no differences in patient-reported outcomes were noted between the 2 groups.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.