Factors Associated with Knee Stiffness following Surgical Management of Multiligament Knee Injuries

2016 ◽  
Vol 30 (06) ◽  
pp. 549-554 ◽  
Author(s):  
Robert Westermann ◽  
Shane Cook ◽  
Natalie Glass ◽  
Ned Amendola ◽  
Brian Wolf ◽  
...  
Keyword(s):  
External Fixation ◽  
Knee Injuries ◽  
Postoperative Phase ◽  
Postoperative Rehabilitation ◽  
Manipulation Under Anesthesia ◽  
Factors Associated ◽  
Knee Stiffness ◽  
Acute Surgery ◽  
Multiligament Knee Injuries

AbstractPostoperative knee stiffness can influence outcomes following operative treatment of multiligament knee injuries (MLKIs). The purpose of this study was to evaluate patient and surgical factors that may potentially contribute to stiffness following surgery for MLKIs. All surgically managed MLKIs involving two or more ligaments over a 10-year period at a single level one trauma center were included in this study. A retrospective review was performed to gather objective data related to the development of knee stiffness after surgery. Patients were classified as “stiff” postoperatively if they (1) had a flexion contracture greater than 10 degrees, (2) failed to reach 120 degrees of flexion at final follow-up, or (3) underwent a manipulation under anesthesia with or without arthroscopic lysis of adhesions to improve range of motion. Patient and surgical factors were evaluated systematically to determine factors associated with stiffness. The mean age of the cohort was 27.6 years at the time of surgery and mean follow-up was 50 weeks. Overall, 26/121 (21.5%) knees were diagnosed with postoperative stiffness. In the acute postoperative phase, 17 patients underwent manipulation under anesthesia. There were no significant differences in age, body mass index, associated injuries, mechanism, external fixation use or surgical timing (acute vs. chronic) between stiff and normal knees. Factors associated with the development of postoperative stiffness included knee dislocation (p = 0.04) and surgical intervention on three or more ligaments (p = 0.04). Careful attention to postoperative rehabilitation regimens should be given to patients with knee dislocations and/or those undergoing reconstruction or repair of three or more injured ligaments. Surgeons may utilize spanning external fixation if necessary without increasing the rate of long-term stiffness. Further, acute surgery does not appear to influence rates of postoperative stiffness or the need for manipulation.

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction

2021 ◽  
Author(s):  
Marcel Faraco Sobrado ◽  
Pedro Nogueira Giglio ◽  
Marcelo Batista Bonadio ◽  
Jose Ricardo Pecora ◽  
Riccardo Gomes Gobbi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ligament Reconstruction ◽  
Independent Predictor ◽  
Knee Injuries ◽  
Knee Dislocation ◽  
Postoperative Rehabilitation ◽  
Radiographic Osteoarthritis ◽  
High Incidence ◽  
Multiligament Knee Injuries

AbstractThe aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% (n = 10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n = 40) presented a KL classification of ≥2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n = 7) also presented arthritis in the contralateral knee, in 53.2% (n = 33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio = 13.2 [p = 0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.

scholarly journals Multiligament Knee Injuries in Older Adolescents: A 2-Year Minimum Follow-up Study

2017 ◽  
Vol 5 (9) ◽  
pp. 232596711772771 ◽  
Author(s):  
Jonathan A. Godin ◽  
Mark E. Cinque ◽  
Jonas Pogorzelski ◽  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
...  
Keyword(s):  
Knee Injuries ◽  
Follow Up Study ◽  
Older Adolescents ◽  
Multiligament Knee Injuries

Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction

2018 ◽  
Vol 32 (06) ◽  
pp. 560-564 ◽  
Author(s):  
John R. Worley ◽  
Olubusola Brimmo ◽  
Clayton W. Nuelle ◽  
James L. Cook ◽  
James P. Stannard
Keyword(s):  
Return To Work ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Knee Injuries ◽  
Knee Reconstruction ◽  
Level Of Activity ◽  
Previous Level ◽  
Peroneal Nerve Injury ◽  
Multiligament Knee Injuries

AbstractThe purpose of this study was to determine incidence of concurrent peroneal nerve injury and to compare outcomes in patients with and without peroneal nerve injury after surgical treatment for multiligament knee injuries (MLKIs). A retrospective study of 357 MLKIs was conducted. Patients with two or more knee ligaments requiring surgical reconstruction were included. Mean follow-up was 35 months (0–117). Incidence of concurrent peroneal nerve injury was noted and patients with and without nerve injury were evaluated for outcomes. Concurrent peroneal nerve injury occurred in 68 patients (19%). In patients with nerve injury, 45 (73%) returned to full duty at work; 193 (81%) patients without nerve injury returned to full duty (p = 0.06). In patients with nerve injury, 37 (60%) returned to their previous level of activity; 148 (62%) patients without nerve injury returned to their previous level of activity (p = 0.41). At final follow-up, there were no significant differences in level of pain (mean visual analog scale 1.6 vs. 2; p = 0.17), Lysholm score (mean 88.6 vs. 88.8; p = 0.94), or International Knee Documentation Committee score (mean 46.2 vs. 47.8; p = 0.67) for patients with or without peroneal nerve injury, respectively. Postoperative range of motion (ROM) (mean 121 degrees) was significantly lower (p = 0.02) for patients with nerve injury compared with patients without nerve injury (mean 127 degrees). Concurrent peroneal nerve injury occurred in 19% of patients in this large cohort suffering MLKIs. After knee reconstruction surgery, patients with concurrent peroneal nerve injuries had significantly lower knee ROM and trended toward a lower rate of return to work. However, outcomes with respect to activity level, pain, and function were not significantly different between the two groups. This study contributes to our understanding of patient outcomes in patients with concurrent MLKI and peroneal nerve injury, with a focus on the patient's ability to return to work and sporting activity.

scholarly journals Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110278
Author(s):  
Ryan S. Marder ◽  
Husain Poonawala ◽  
Jorge I. Pincay ◽  
Frank Nguyen ◽  
Patrick F. Cleary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Intervention Group ◽  
Knee Injuries ◽  
Cochrane Library ◽  
The Mean ◽  
Multiligament Knee Injuries ◽  
Level 2

Background: The optimal timing of surgical intervention for multiligament knee injuries remains controversial. Purpose: To review the clinical and functional outcomes after acute and delayed surgical intervention for multiligament knee injuries. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to September 2020. Eligible studies reported on knee dislocations, multiligament knee injuries, or bicruciate ligament injuries in adult patients (age, ≥18 years). In addition to comparing outcomes between acute and delayed surgical intervention groups, we conducted 3 subgroup analyses for outcomes within isolated knee injuries, knee injuries with concomitant polytrauma/fractures, and high-level (level 2) studies. Results: Included in the analysis were 31 studies, designated as evidence level 2 (n = 3), level 3 (n = 8), and level 4 (n = 20). These studies reported on 2594 multiligament knee injuries sustained by 2585 patients (mean age, 25.1-65.3 years; mean follow-up, 12-157.2 months). At the latest follow-up timepoint, the mean Lysholm (n = 375), International Knee Documentation Committee (IKDC) (n = 286), and Tegner (n = 129) scores for the acute surgical intervention group were 73.60, 67.61, and 5.06, respectively. For the delayed surgical intervention group, the mean Lysholm (n = 196), IKDC (n = 172), and Tegner (n = 74) scores were 85.23, 72.32, and 4.85, respectively. The mean Lysholm (n = 323), IKDC (n = 236), and Tegner (n = 143) scores for our isolated subgroup were 83.7, 74.8, and 5.0, respectively. By comparison, the mean Lysholm (n = 270), IKDC (n = 236), and Tegner (n = 206) scores for the polytrauma/fractures subgroup were 83.3, 64.5, and 5.0, respectively. Conclusion: The results of our systematic review did not elucidate whether acute or delayed surgical intervention produced superior clinical and functional outcomes. Although previous evidence has supported acute surgical intervention, future prospective randomized controlled trials and matched cohort studies must be completed to confirm these findings.

Anatomic Reconstruction of the Posterior Cruciate Ligament after Multiligament Knee Injuries: A Combination of the Tibial-Inlay and Two-Femoral-Tunnel Techniques

2003 ◽  
Vol 31 (2) ◽  
pp. 196-202 ◽  
Author(s):  
James P. Stannard ◽  
Reneé S. Riley ◽  
Todd M. Sheils ◽  
Gerald McGwin ◽  
David A. Volgas
Keyword(s):  
Posterior Cruciate Ligament ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Anatomic Reconstruction ◽  
Joint Stability ◽  
Posterior Displacement ◽  
Multiligament Knee Injuries ◽  
Tibial Inlay

Background: Neither operative nor nonoperative treatment of posterior cruciate ligament rupture after multiligament knee injuries have shown very favorable outcomes. Hypothesis: Reconstruction of the posterior cruciate ligament by combining the tibial-inlay and two-femoral-tunnel techniques will result in improved stability and functional outcomes. Study Design: Prospective cohort study. Methods: Twenty-nine patients with 30 posterior cruciate ligament ruptures and multiligament knee injuries treated with the combined technique were evaluated with clinical, radiographic, and functional outcome measures. Results: All patients had a clinical examination result indicating joint stability (0 or 1+) at an average follow-up of 25 months (range, 15 to 39). Twenty-three knees had no laxity, and seven had 1+ laxity. The KT-2000 arthrometer data documented less than 0.5 mm of side-to-side mean difference for both posterior displacement and total anterior-posterior displacement at both 30° and 70° of knee flexion. Knee range of motion was a mean extension of 1° (range, 0° to 10°) and a mean flexion of 124° (range, 75° to 145°). Mean Lysholm knee score was 89.4. Conclusions: Reconstruction with a combination tibial-inlay and two-femoral-tunnel technique provides good results after multiligament knee injuries. All patients had a stable posterior cruciate ligament at most recent clinical follow-up, and 77% had no laxity at all.

scholarly journals Correction to: Factors associated with poorer outcomes in the surgical treatment of multiligament knee injuries

2018 ◽  
Vol 27 (2) ◽  
pp. 460-460
Author(s):  
Eduard Alentorn-Geli ◽  
Alexander L. Lazarides ◽  
Gangadhar M. Utturkar ◽  
Heather S. Myers ◽  
Kristian Samuelsson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Knee Injuries ◽  
Factors Associated ◽  
Multiligament Knee Injuries

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

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