Medial and Patellofemoral Compartment Chondral Damage Increases With Delayed Surgical Treatment of Multiligament Knee Injuries.

BACKGROUND

Multiligament knee injuries (MLKIs) are complex and challenging, with significant long-term consequences. While previous studies have examined chondral injuries in MLKI over time, there are limited data regarding their development during the interval between injury and surgery.

HYPOTHESIS

MLKIs with increased time interval between injury and surgery will be associated with an increased incidence of chondral injuries.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This retrospective review utilized a multisurgeon database, including patients with MLKI treated from April 2008 to October 2022. Inclusion criteria were MLKI requiring surgical intervention, available operative reports, and documented date of injury in the electronic medical record. MLKIs were categorized by time interval from injury to surgery (acute, 0-90 days; delayed, 91-365 days; late, >365 days). The location and pattern of meniscal and chondral injuries were evaluated accordingly. Compartment injury patterns were also analyzed based on cruciate ligament injury pattern.

RESULTS

A total of 206 patients were included (acute, n = 138; delayed, n = 54; late, n = 14). The delayed and late groups had significantly higher mean numbers of chondral surface injury (out of 6 total surfaces evaluated) compared with the acute group (delayed, 1.79; late, 1.52; acute, 0.70; = .002). Trochlear cartilage injuries occurred significantly more frequently in the delayed (28%) compared with the acute group (9%; = .003). Similarly, patellar cartilage injuries were more common in the delayed (30%) compared with acute patients (12%; = .02). Medial femoral condylar chondral injuries were significantly increased in the delayed (30%) and late (50%) groups compared with acute (15%; = .002). Medial tibial plateau cartilage injuries followed the same pattern (acute, 13%; delayed, 30%; late, 43%; = .002). Patients with bicruciate MLKIs undergoing surgery after 90 days showed significantly higher trochlear (31% vs 8%; = .04) and patellar cartilage injury rates (35% vs 11%; = .03). ACL-based MLKIs operated beyond 90 days had increased rates of trochlear (22% vs 8%; = .03), medial femoral condylar (30% vs 13%; = .02), and medial tibial plateau (27% vs 11%; = .03) cartilage injury. PCL-based MLKI patients undergoing delayed surgery (>90 days) also had significantly higher medial femoral condylar (71% vs 8%; = .004) and medial tibial plateau (71% vs 8%; = .01) cartilage injury rates. Meniscal injury rates did not differ significantly across time groups.

CONCLUSION

Patients who underwent delayed surgery for their MLKI injuries had more medial and patellofemoral cartilage injuries at the time of surgery than those treated within 30 days of injury.